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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by neo on November 24, 2004, at 14:27:55
Hi,
In your experience, take sulpiride 1 a day before sleep could be enough, or it must be taken twice a day?
I have noticed that after 2 hours from assumption and during the followings 4 h, it give me heavy somnolence (indipendent from the dosage), so i think it should be better to take at night and to seep on it.
But i do not if its half live is enough long to take only once a day.
Thanx for your help!!!!
neo
Posted by SLS on November 24, 2004, at 19:03:25
In reply to SULPIRIDE user: once a day could be enough?, posted by neo on November 24, 2004, at 14:27:55
> Hi,
> In your experience, take sulpiride 1 a day before sleep could be enough, or it must be taken twice a day?
The half-life of sulpiride is 8 hours, which is relatively short. It should be taken twice a day.
- Scott
Posted by Pluto on November 25, 2004, at 3:34:10
In reply to SULPIRIDE user: once a day could be enough?, posted by neo on November 24, 2004, at 14:27:55
Why you are on it? Are you on
the antipsychotic dose or antidepressant
dose? For psychosis upto 900mg is used, but
for pure anxiolysis or antidepressant effect
lower than 200mg is enough. Higher doses tends
to stay in your system much longer. Without
knowing the strength of your intake, it is
difficult to answer your question
PLS
Posted by neo on November 25, 2004, at 5:00:24
In reply to Re: SULPIRIDE user: once a day could be enough?, posted by Pluto on November 25, 2004, at 3:34:10
You are right, for being concise i forgot to say impotant things.
I'm a unipolar depressed (melanchonic, anenergic, anedhonic....)
Every classic ad failed completely.
Only sulpiride gave me a sensible increase in my energy, mood,...
I'm on 150 mg day that seems to be enough for me( i'm particular sensible to dosage).
Ah, i forgot, amisulpride (the sulpiride newest derivate) did a lot for me, but its effects lasts only 24 hours and stop working with the dosage of the following day: the why not yet i know!
Thanx very much for your share!
neo
Posted by alexandra_k on November 26, 2004, at 21:56:39
In reply to Re: SULPIRIDE user: once a day could be enough? » Pluto, posted by neo on November 25, 2004, at 5:00:24
Sorry, couldn't resist :-)
Cool posting name.
Posted by neo on November 27, 2004, at 11:23:29
In reply to WHAT IS THE MATRIX? » neo, posted by alexandra_k on November 26, 2004, at 21:56:39
Posted by Pluto on November 27, 2004, at 23:00:30
In reply to Re: SULPIRIDE user: once a day could be enough? » Pluto, posted by neo on November 25, 2004, at 5:00:24
Sorry for this late input. If you are on the AD dosage, probably you will have to take it twice daily. It's duration of action is somewhere in between 8 to 10 hours. But individual responses always vary. If you find it effective after once daily dosing, stick with that schedule. All you need is symptom relief, not any approval from other folks.
Meanwhile, you wrote Amisulpiride worked for single day and then fade out. I too experienced this with sulpiride. It gave an unusual high and energy for the first day I took it, but I failed maintain that effect the very next day. I stopped taking it and restarted again, then the same feeling occured. The high sulpiride induces is short lived, but the anxiolytic effect plus that mild AD effect remains. The only bad side of sulpiride for me is it makes me too lethargic. I don't know why?
PLS
Posted by neo on November 28, 2004, at 6:12:22
In reply to Re: SULPIRIDE user: once a day could be enough? » neo, posted by Pluto on November 27, 2004, at 23:00:30
Posted by neo on November 28, 2004, at 6:22:58
In reply to Re: SULPIRIDE user: once a day could be enough? » neo, posted by Pluto on November 27, 2004, at 23:00:30
Hi Pluto, a simple question:
How long should you stop sulpiride before restart again to take it with the same effect as the first dosage?
What dosage of sulpiride was you on?Thanx for your help, apolog for my hawful English, but i think you will understand however!
Bye
neo
Posted by Pluto on November 28, 2004, at 23:28:24
In reply to PLUTO: SULPIRIDE timing and dosage., posted by neo on November 28, 2004, at 6:22:58
Hi Neo,
Quite a few days, or maximum one week is enough to restart and experience that unusual high on sulpiride. But it is sad however that the effect is not long lasting, even after doubling the dosage. Taking more than 200mg only adds to the lethargic feeling and fatigue. 150 mg is ideal for me. I too try to dose it once daily. Yesterday I took 100 mg at night and slept nicely waking today fresh and less lethargic. Let me see what happens as the day progresses. I still have 50mg more to take, which I think I will dose in the evening. I will keep you updated if you are interested. I am also keen to know what happens to you when you dose it all at night.
Will be happy to hear from you. Cheers,
PLS
Posted by Iansf on November 29, 2004, at 0:13:19
In reply to Re: PLUTO: SULPIRIDE timing and dosage. » neo, posted by Pluto on November 28, 2004, at 23:28:24
> Hi Neo,
>
> Quite a few days, or maximum one week is enough to restart and experience that unusual high on sulpiride. But it is sad however that the effect is not long lasting, even after doubling the dosage.
> PLSWhat about the possibility that sulpiride takes time to be effective, just like antidepressants? Perhaps the effect doesn't truly kick in for four weeks or more and that the first-day effect is an anomaly of some sort.
Posted by Pluto on November 29, 2004, at 0:58:50
In reply to Re: PLUTO: SULPIRIDE timing and dosage. » Pluto, posted by Iansf on November 29, 2004, at 0:13:19
Hi Dear,
Good question. First of all amisulpride, sulpiride and flupenthixol (Fluanxol) are not first line antidepressants. (Interestingly these drugs are not available in U.S) When other antidepressants fail or patients find it hard to tolerate their side effects, docs use these drugs as alternatives. And unlike traditional antidepressants, amisulpride, sulpiride and flupenthixol exert their efficacy within a few days or I would say within hours. It is because they target Dopamine receptors in the brain to stimulate them indirectly to create a mood elevation. For instance I can feel the anxiolytic effect of sulpiride within hours after taking it along with a lift in mood. But for unknown reasons I don't feel the initial high to be long lasting, but anxiolysis remains plusa mild alerting or call it antidepressant effect. I have been taking it for a long time, and can confirm the antidepressant effect is gradually declining. I would say, sulpiride would rather be an anxiolytic. An effective anxiolytic, and a mild antidepressant.
Amisulpride on the other hand is more potent than sulpiride hence is more of an Antidepressant. I haven't used it, so can't comment.
Flupenthixol in doses lower than 3 mg is having an activating effect. It is similar to those of sulpiride and perhaps amisulpride. But once again the mood elevation was short lived, and most importanly it triggered another episode of major depression in me after using it over a month or so in the past. Luckily sulpiride is not doing the same, and I hope never will.
Cheers
Posted by ed_uk on November 29, 2004, at 5:44:56
In reply to Re: PLUTO: SULPIRIDE timing and dosage. » Iansf, posted by Pluto on November 29, 2004, at 0:58:50
Fluanxol was popular in the UK before the SSRIs were introduced. It is rarely prescribed these days!
Ed
Posted by neo on November 29, 2004, at 11:45:49
In reply to Re: PLUTO: SULPIRIDE timing and dosage. » Pluto, posted by Iansf on November 29, 2004, at 0:13:19
Iansf,
>>What about the possibility that sulpiride takes time to be effective, just like antidepressants? Perhaps the effect doesn't truly kick in for four weeks or more and that the first-day effect is an anomaly of some sort. >>
You could be right! But for my personal case i think sulpiride acts only like neurolepthic not like AD.
None effects lasts over day 10 (max) only sleepiness (sulpiride for me remain a great sleeping pill).
Pluto,I will be very glad if you'll update me about your trial!!
My opinion and experience for my personal case:
Sulpiride is mainly sedative, Amisulpride is mainly activatig.
Sulpiride is milder, Amisulpride is more powerfull. Even if they bind same dopamine D2 D3 receptors i think the way of working is a little different.
Sulp poop out = sedation and aphaty.
Ami poop out = dizzyness and aphaty.For my personal case i think Ami is superior, i need to be activated and it gave me a wonder feeling for life (even if only for a day).
Today Sulpiride stop working (at day 9), i will clear for about 4-5 day and retry with Amisulpride.
I will try to find out a working schedule.I will let you know how it is going!
Best for you all!!
neo
Posted by gromit on December 1, 2004, at 2:05:55
In reply to SULPIRIDE timing and dosage. Everybody., posted by neo on November 29, 2004, at 11:45:49
Is there something approved in the U.S. that is similar to it?
Thanks
Rick
Posted by ed_uk on December 1, 2004, at 8:08:30
In reply to Amisulpride, posted by gromit on December 1, 2004, at 2:05:55
Do you have flupenthixol in the US?
Ed.
Posted by iris2 on December 1, 2004, at 19:07:57
In reply to Re: Amisulpride, posted by ed_uk on December 1, 2004, at 8:08:30
I just stopped Amisulpride because of a lot of weight gain and elevated prolactin levels which stopped my period. Can you tell me more about this medication. I looked it up and it has the same possibility of side effects but a lot of other drugs do too and I did not get them. I am wondering if this is very similar to Amisulpride and if there is less chance of these side effects?
thanks,
irene
Posted by gromit on December 2, 2004, at 0:16:34
In reply to Re: Amisulpride, posted by ed_uk on December 1, 2004, at 8:08:30
Posted by ed_uk on December 3, 2004, at 7:26:47
In reply to flupenthixol doesn't seem to be available here (nm) » ed_uk, posted by gromit on December 2, 2004, at 0:16:34
Hi!
Were you asking me about flupenthixol? I think you were so I'll say a bit about it.
Flupenthixol (recently renamed flupentixol) is a typical antipsychotic. High doses have an effect similar to haloperidol (Haldol) and are used for the treatment of psychotic disorders. Side effects are very common when high doses are used. Very low doses are said to have an antidepressant effect. Side effects are much less common with very low doses. In England, low dose tablets are called Fluanxol, high dose tablets are called Depixol.
Low doses of flupenthixol sometimes cause hyperprolactinemia. The chance of your prolactin being raised be Fluanxol is probably fairly high. Even so, it might be worth a try, especially if you have tolerated other typical APs well in the past. Which APs have you taken before and not experienced hyperprolactinemia?
Here is the UK data sheet for Fluanxol...
1. NAME OF THE MEDICINAL PRODUCT
Fluanxol Tablets 0.5 and 1 mg
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
0.5 mg tablets (containing 0.584 mg flupentixol dihydrochloride equivalent to 0.5 mg flupentixol base). 1 mg tablets (containing 1.168 mg flupentixol dihydrochloride equivalent to 1 mg flupentixol base).
3. PHARMACEUTICAL FORM
Round, biconvex, red, sugar-coated tablets.
4. CLINICAL PARTICULARS
4.1 Therapeutic indications
Symptomatic treatment of depression (with or without anxiety).
4.2 Posology and method of administration
Route of administration: Oral.Adults: The standard initial dosage is 1 mg as a single morning dose. After one week the dose may be increased to 2 mg if there is inadequate clinical response. Daily dosage of more than 2 mg should be in divided doses up to a maximum of 3 mg daily.
Elderly: The standard initial dosage is 0.5 mg as a single morning dose. After one week, if response is inadequate, dosage may be increased to 1 mg once a day. Caution should be exercised in further increasing the dosage but occasional patients may require up to a maximum of 2 mg a day which should be given in divided doses.
Children: Not recommended for children.
Patients often respond within 2-3 days. If no effect has been observed within one week at maximum dosage the drug should be withdrawn.
4.3 Contraindications
Severe depression requiring ECT or hospitalisation, states of excitement or overactivity, including mania.
4.4 Special warnings and special precautions for use
Caution should be exercised in patients having: liver disease; cardiac disease or arrhythmias; severe respiratory disease; renal failure; epilepsy (and conditions predisposing to epilepsy e.g. alcohol withdrawal or brain damage); Parkinson's disease; narrow angle glaucoma; prostatic hypertrophy; hypothyroidism; hyperthyroidism; myasthenia gravis; phaeochromocytoma and patients who have shown hypersensitivity to thioxanthenes or other antipsychotics.The elderly require close supervision because they are specially prone to experience such adverse effects as sedation, hypotension, confusion and temperature changes.
Recurrence of depressive symptoms on abrupt withdrawal is rare. Acute withdrawal symptoms, including nausea, vomiting, sweating and insomnia have been described after abrupt cessation of thioxanthenes and similar drugs. The emergence of involuntary movement disorders (such as akathisia, dystonia and dyskinesia) has been reported. Therefore, gradual withdrawal is advisable.
Dependence has not been reported to date.
4.5 Interaction with other medicinal products and other forms of Interaction
In common with other similar drugs, flupentixol enhances the response to alcohol, the effects of barbiturates and other CNS depressants. Flupentixol may potentiate the effects of general anaesthetics and anticoagulants and prolong the action of neuromuscular blocking agents.The anticholinergic effects of atropine or other drugs with anticholinergic properties may be increased. Concomitant use of drugs such as metoclopramide, piperazine or antiparkinson drugs may increase the risk of extrapyramidal effects such as tardive dyskinesia. Combined use of antipsychotics and lithium or sibutramine has been associated with an increased risk of neurotoxicity.
Antipsychotics may enhance the cardiac depressant effects of quinidine; the absorption of corticosteroids and digoxin. The hypotensive effect of vasodilator antihypertensive agents such as hydralazine and αblockers (e.g. doxazosin), or methyl-dopa may be enhanced. Concomitant use of flupentixol and drugs known to cause QT prolongation or cardiac arrhythmias, such as tricyclic antidepressants, other antipsychotics or terfenadine should be avoided.
Antipsychotics may antagonise the effects of adrenaline and other sympathomimetic agents, and reverse the antihypertensive effects of guanethidine, possibily clonidine and similar adrenergic-blocking agents. Antipsychotics may also impair the effect of levodopa, adrenergic drugs and anticonvulsants.
The metabolism of tricyclic antidepressants may be inhibited and the control of diabetes may be impaired.
4.6 Pregnancy and lactation
As the safety of Fluanxol in human pregnancy has not been established, use during pregnancy, especially the first and last trimesters, should be avoided unless the expected benefit to the patient outweighs the potential risk to the foetus.Flupentixol is excreted into the breast milk. If the use of Fluanxol is considered essential, nursing mothers should be advised to stop breast feeding.
The newborn of mothers treated with antipsychotics in late pregnancy, or labour, may show signs of intoxication such as lethargy, tremor and hyperexcitability, and have a low apgar score.
4.7 Effects on ability to drive and use machines
Alertness may be impaired, especially at the start of treatment, or following the consumption of alcohol; patients should be warned of this risk and advised not to drive or operate machinery until their susceptibility is known. Patients should not drive if they have blurred vision.
4.8 Undesirable effects
Drowsiness and sedation are unusual. Sedation, if it occurs, is more often seen with high dosage and at the start of treatment, particularly in the elderly. Other adverse effects include blurring of vision, tachycardia and urinary incontinence and frequency. Dose-related postural hypotension may occur, particularly in the elderly.Extrapyramidal reactions in the form of acute dystonias (including oculogyric crisis), parkinsonian rigidity, tremor, akinesia and akathisia have been reported and may occur even at lower dosage in susceptible patients. Such effects would usually be encountered early in treatment, but delayed reactions may also occur. If they do occur, treatment with Fluanxol should be withdrawn. Antiparkinson agents should not be prescribed routinely because of the possible risk of precipitating toxic-confusional states, impairing therapeutic efficacy or causing anticholinergic side-effects. They should only be given if required and their requirement reassessed at regular intervals. Precipitation of hypomania has been occasionally reported.
Tardive dyskinesia can occur with antipsychotic treatment. It is more common at high doses for prolonged periods but has been reported at lower dosage for short periods. The risk seems to be greater in the elderly, especially females. It has been reported that fine vermicular movements of the tongue are an early sign. It has been observed occasionally in patients receiving Fluanxol. The concurrent use of anticholinergic antiparkinson drugs may exacerbate this effect. The potential irreversibility and seriousness, as well as the unpredictability of the syndrome, requires especially careful assessment of the risk versus benefit, and the lowest possible dosage and duration of treatment consistent with therapeutic efficacy. Short-lived dyskinesia may occur after abrupt withdrawal of the drug (see section 4.4).
The neuroleptic malignant syndrome has rarely been reported in patients receiving antipsychotics, including flupentixol. This potentially fatal syndrome is characterised by hyperthermia, a fluctuating level of consciousness, muscular rigidity and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating and urinary incontinence. Antipsychotic therapy should be discontinued immediately and vigorous symptomatic treatment implemented.
Epileptic fits have occasionally been reported. Confusional states can occur.
The hormonal effects of antipsychotic drugs include hyperprolactinaemia, which may be associated with galactorrhoea, gynaecomastia, oligomenorrhoea or amenorrhoea. Sexual function, including erection and ejaculation may be impaired; but increased libido has also been reported.
Flupentixol may impair body temperature control, and cases of hyperthermia have occurred rarely. The possible development of hypothermia, particularly in the elderly and hypothyroid, should be borne in mind.
Blood dyscrasias have occasionally been reported. Blood counts should be carried out if a patient develops signs of persistent infection. Jaundice and other liver abnormalities have been reported rarely.
Weight gain and less commonly weight loss have been reported; oedema has occasionally been reported and has been considered to be allergic in origin. Rashes have occurred rarely. Although less likely than with phenothiazines, flupentixol can rarely cause increased susceptibility to sunburn.
Other reactions that have been reported rarely at low doses include nausea, dizziness or headache, migraine, excitement, agitation, or unpleasant subjective feelings of being mentally dulled or slowed down. Other occasional side effects are restlessness and insomnia.
4.9 Overdose
ECG changes with prolongation of the QT interval and T-wave changes may occur with moderate to high doses; they are reversible on reducing the dose.Overdosage may cause somnolence, or even coma, extrapyramidal symptoms, convulsions, hypotension, shock, hyper-or hypothermia. Treatment is symptomatic and supportive, with measures aimed at supporting the respiratory and cardiovascular systems. The following specific measures may be employed if required.
-
anticholinergic antiparkinson drugs if extrapyramidal symptoms occur.
-
sedation (with benzodiazepines) in the unlikely event of agitation or excitement or convulsions
-
noradrenaline in saline intravenous drip if the patient is in shock. Adrenaline must not be given.
-
gastric lavage should be considered
5. PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
The precise pharmacological mode of action of flupentixol has not been determined. It has been postulated that at low dosage flupentixol binds to presynaptic dopamine receptors causing increased neurotransmitter release. There is evidence that postsynaptic aminergic receptors become down regulated in response to increased levels of neurotransmitter and this is responsible for the observed improvement in depressive symptoms.
5.2 Pharmacokinetic properties
Mean oral bioavailability is about 55%. Maximum drug serum concentrations occur about 4 hours after dosing and the biological half-life is about 35 hours. Flupentixol is widely distributed in the body. Metabolism is by sulphoxidation, N-dealkylation and glucuronic acid conjugation. Excretion is via the urine and faeces.
5.3 Preclinical safety data
Nil of relevance
6. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Potato starch, Lactose, Gelatin, Talc, Magnesium Stearate, Sucrose and Ultralake Ponceau 4R (E124)
6.2 Incompatibilities
None known.
6.3 Shelf life
Fluanxol tablets are stable for 3 years. The box is labelled with an expiry date.
6.4 Special precautions for storage
Do not store above 30°C.
6.5 Nature and contents of container
PVC/PVdC blister strips of 60 tablets per box.
6.6 Instructions for use and handling (and disposal)
Nil.
7. MARKETING AUTHORISATION HOLDER
Lundbeck Ltd
Lundbeck House
Caldecotte Lake Business Park
Caldecotte
Milton Keynes
MK7 8LF
8. MARKETING AUTHORISATION NUMBER(S)
Fluanxol Tablets 0.5 mg
PL 00458/0011R
Fluanxol Tablets 1 mg
PL 00458/0037
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
First Authorisation
23 September 1982
Renewal of Authorisation
17 March 2002
10. DATE OF REVISION OF THE TEXT
July 2002® Trademark
Posted by iris2 on December 3, 2004, at 12:47:54
In reply to Re: flupenthixol- to Irene, posted by ed_uk on December 3, 2004, at 7:26:47
Flupenthixol was what I was asking about. Thanks for all the information.
I have taken perphenazine on and off for a long time and did not have hyperprolactinemia. When I started a low dose of Amisulpride I had hyperprolactinemia almost immediately an dmy period stopped and I gained weight immediately in very specific places like my stomach. I have just gone off of it again and am not having a good time of it but I am bulimic and the weight issue and body changes were making me nuts. Rationally I know that I should stay on it but I have become even more of a hermit from the weight gain and I could not stand it anymore. I was thinking that perhaps I could get a similar result with a small dose of Flupenthixol but from what you wrote I think I would have the same problems. The perphenazine does not help as much as the Amisulpride did. I think if it had helped me function more or helped the anhedonia at all I might have tried to stay on it more.
Let me know what you think I appreciate the input.
irene
Posted by ed_uk on December 3, 2004, at 13:36:10
In reply to Re: flupenthixol- to Irene » ed_uk, posted by iris2 on December 3, 2004, at 12:47:54
Hi!
If you didn't get hyperprolactinemia from the perphenazine you might not get it from flupenthixol either. A high dose of flupenthixol would be expected to have an effect similar to perphenazine but a low dose of flupenthixol can produce AD effects (which may resemble the effect of low-dose amisulpride.) After all, flupenthixol has been hypothesised to have an AD effect via the same mechanism as amisulpride. To quote the data sheet.... 'It has been postulated that at low dosage flupentixol binds to presynaptic dopamine receptors causing increased neurotransmitter release.'
If I were you I'd probably try Fluanxol. If you don't like it you don't have to continue it! I'd start with a very low dose and increase gradually if necessary. It's important to find the minimum effective dose. Too high a dose could be less effective and have many more side effects. In the weight gain department, flupenthixol usually isn't too offensive- but weight gain is still a possibility. Flupenthixol can cause tardive dyskinesia(TD), the risk is higher than with amisulpride. Since TD can be permanent, this is an important consideration. The risk is minimised by finding the lowest effective dose. Intermittent treatment, rather than long-term continuous treatment might be desirable. Flupenthixol is usually effective after taking a suitable dose for about a week. If you don't benefit within a few weeks then you probably never will!
Is flupenthixol (Fluanxol) available where you live?
Regards,
Ed.
Posted by iris2 on December 4, 2004, at 20:14:12
In reply to Re: flupenthixol- to Irene, posted by ed_uk on December 3, 2004, at 13:36:10
Thanks for answering my questions. I am not sure if it is available where I live but I saw it is avialable via the internet. I am not sure what I am going to do yet. I think if I can hold out I need to get my bladder pain from a bladder desease I have under control first because most of these meds cause the pain too and I will not know if it is the med or not.
Thanks,
irene
Posted by Pluto on December 4, 2004, at 22:53:56
In reply to Re: flupenthixol- to Irene » ed_uk, posted by iris2 on December 4, 2004, at 20:14:12
HiIris,
Flupenthixol worked great for me for the first week, then the good effects disappeared for side effects like akathisia to persist. It triggered another major depressive episode after one month of use and was very difficult to get normalized even after stopping the drug completely. I was on 1mg. This is a cautionary notice prior to using this potent neuroleptic. Be careful.
PLS
Posted by ed_uk on December 5, 2004, at 2:14:36
In reply to Re: flupenthixol- to Irene » ed_uk, posted by iris2 on December 4, 2004, at 20:14:12
Hi,
If you do decide to start flupenthixol you should probably start with a dose of 0.5 mg/day (500mcg). It's important to find the minimum effective dose, 0.5mg/day is enough for some people.
Best Wishes,
Ed.
Posted by iris2 on December 6, 2004, at 9:24:22
In reply to Re: flupenthixol- to Irene » iris2, posted by Pluto on December 4, 2004, at 22:53:56
Thanks,
That ws good to know especially since you were on such a small dose. If I do try it I will keep your experience in mind with a keen eye on both the side effects and possible negative effects. I recently tried Mirapex and not only had major negative side effects on a small dose but also it increased my depression.
irene
This is the end of the thread.
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