4.1 Therapeutic indications
Amisulpride is indicated for the treatment of acute and chronic schizophrenic disorders, in which positive symptoms (such as delusions, hallucinations, thought disorders) and/or negative symptoms (such as blunted affect, emotional and social withdrawal) are prominent, including patients characterised by predominant negative symptoms.
4.2 Posology and method of administration
For acute psychotic episodes, oral doses between 400 mg/d and 800 mg/d are recommended. In individual cases, the daily dose may be increased up to 1200 mg/d. Doses above 1200 mg/d have not been extensively evaluated for safety and therefore should not be used. No specific titration is required when initiating the treatment with amisulpride. Doses should be adjusted according to individual response.
For patients with mixed positive and negative symptoms, doses should be adjusted to obtain optimal control of positive symptoms.
Maintenance treatment should be established individually with the minimally effective dose.
For patients characterised by predominant negative symptoms, oral doses between 50 mg/d and 300 mg/d are recommended. Doses should be adjusted individually.
Amisulpride can be administered once daily at oral doses up to 300 mg, higher doses should be administered bid.
The minimum effective dose should be used.
The safety of amisulpride has been examined in a limited number of elderly patients. Amisulpride should be used with particular caution because of a possible risk of hypotension and sedation. Reduction in dosage may also be required because of renal insufficiency.
The efficacy and safety of amisulpride from puberty to the age of 18 years have not been established. There are limited data available on the use of amisulpride in adolescents in schizophrenia. Therefore, the use of amisulpride from puberty to the age of 18 years is not recommended; in children up to puberty amisulpride is contraindicated, as its safety has not yet been established (see section 4.3).
Amisulpride is eliminated by the renal route. In renal insufficiency, the dose should be reduced to half in patients with creatinine clearance (CRCL) between 30 Ã¢Â€Â“ 60 ml/min and to a third in patients with CRCLÂ between 10 Ã¢Â€Â“ 30 ml/min.
As there is no experience in patients with severe renal impairment (CRCLÂ < 10 ml/min) particular care is recommended in these patients (see section 4.4).
Since the drug is weakly metabolised a dosage reduction should not be necessary.
Ã¢Â€Â¢ Hypersensitivity to the active ingredient or to other ingredients of the medicinal product.
Ã¢Â€Â¢ Concomitant prolactin-dependent tumours e.g. pituitary gland prolactinomas and breast cancer (see sections 4.4 and 4.8).
Ã¢Â€Â¢ Children before the onset of puberty.
Ã¢Â€Â¢ Combination with levodopa (see section 4.5).
4.4 Special warnings and precautions for use