II. Indications

  1. Postoperative Nausea and Vomiting
    1. Rescue treatment for those failing Antiemetic prophylaxis
  2. Acute Psychosis or Schizophrenia
    1. Used in europe, but not FDA approved for this use in the United States

III. Contraindications

IV. Precautions

  1. Amisulpride photodegrades and must be used within 12 hours of the vial being removed from its protective carton

V. Mechanism

  1. Selective Dopamine Receptor Antagonist (D2 and D3), blocking activity at the ChemoreceptorTrigger Zone (CTZ)

VI. Dosing

  1. Prevention of Postoperative Nausea and Vomiting (PONV)
    1. Give 5 mg IV over 1-2 minutes at time of Anesthesia induction
  2. Treatment of Postoperative Nausea and Vomiting (PONV)
    1. Give 10 mg IV over 1-2 minutes for single dose at time of perioperative Nausea and Vomiting

VII. Adverse Effects

  1. Hyperprolactinemia
  2. Hypokalemia
  3. Chills
  4. QTc Prolongation
    1. Antiemetic doses have not been associated with QT Prolongation

VIII. Safety

  1. Unknown safety in pregnancy
  2. Avoid in Lactation (or discard pumped Breast Milk for 48 hours)
    1. Amisulpride concentrates in Breast Milk at concentrations up to 20 fold higher than the mother's plasma

IX. Drug Interactions

  1. See Prolonged QT Interval due to Medication
  2. Dopamine Agonists (e.g. Levodopa)
    1. Combined use decreases effect of both the Dopamine Agonist and Amisulpride

XI. References

  1. (2020) Med Lett Drugs Ther 62(1614): 205-7
  2. (2023) Postoperative Nausea and Vomiting Management, Presc Lett, #390431

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