Generic Name

Amisulpride

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Classification

FDA Approved Indications

• Prevention of postoperative nausea and vomiting (PONV)

Mechanism of Action

Amisulpride selectively blocks dopamine D2 and D3 receptors in the central nervous system, which reduces nausea and vomiting signals associated with the chemoreceptor trigger zone (CTZ).

Dosage and Administration

Adult: 10 mg IV administered 30 minutes prior to anesthesia, repeat every 8 hours as needed.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower doses due to increased sensitivity in older adults.

Renal Impairment: Adjust dose based on severity of impairment; consult specific guidelines.

Hepatic Impairment: Use with caution; no specific dose adjustment available.

Pharmacokinetics

Absorption: Rapidly absorbed after IV administration.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Minimal hepatic metabolism.

Excretion: Primarily excreted unchanged in urine.

Half Life: Approximately 12 hours.

Contraindications

• Hypersensitivity to amisulpride or other dopamine antagonists.

Precautions

• Use cautiously in Parkinson’s disease, history of seizures, or QT prolongation.
• Monitor for extrapyramidal symptoms.
• Use caution in patients with renal impairment.

Adverse Reactions - Common

• Drowsiness, dizziness (Common)
• Dystonia, akathisia (Common)

Adverse Reactions - Serious

• QT prolongation, torsades de pointes (Serious)
• Neuroleptic malignant syndrome (Serious)
• Extrapyramidal symptoms (Serious)

Drug-Drug Interactions

• Other medications that prolong QT interval (e.g., certain antidepressants, antiarrhythmics)
• CNS depressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Instruct patient to report dizziness, abnormal heartbeat, or signs of allergic reaction promptly.
• Advise on the importance of hydration and avoiding other QT-prolonging medications.
• Explain purpose of medication as part of anesthesia plan.

Special Considerations

Black Box Warnings:

• Prolonged QT interval, which can lead to serious arrhythmias.

Genetic Factors: Genetic variations may affect drug metabolism and response.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Severe hypotension, extrapyramidal symptoms, QT prolongation, seizures.

Treatment: Supportive care, cardiac monitoring, activated charcoal if ingestion is recent, magnesium sulfate for QT prolongation, and other supportive measures.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable in unopened vials; use within manufacturer-specified period after opening.