Abstract
PurposePrevious studies have demonstrated sulpiride to be significantly more effective than haloperidol, risperidone and olanzapine in schizophrenic treatment; however, only limited information is available on the potential risks associated with sulpiride treatment. This study attempts to provide information on the potential risks of sulpiride treatment of schizophrenia, especially with regard to unexpected adverse effects.Materials and MethodsPatients with schizophrenia aged 18 and older, newly prescribed with a single antipsychotic medication from the National Health Insurance Research Database of Taiwan in the period from 2003 to 2010 were included. A within-subject comparison method, prescription sequence symmetry analysis (PSSA) was employed to efficiently identify potential causal relationships while controlling for potential selection bias.ResultsA total of 5,750 patients, with a mean age of 39, approximately half of whom were male, constituted the study cohort. The PSSA found that sulpiride was associated with EPS (adjusted SR, 1.73; 95% CI, 1.46–2.06) and hyperprolactinemia (12.04; 1.59–91.2). In comparison, EPS caused by haloperidol has a magnitude of 1.99 when analyzed with PSSA, and hyperprolactinemia caused by amisulpride has a magnitude of 8.05, respectively. Another finding was the unexpected increase in the use of stomatological corticosteroids, emollient laxatives, dermatological preparations of corticosteroids, quinolone antibacterials, and topical products for joint and muscular pain, after initiation of sulpiride treatment.ConclusionsWe found sulpiride to be associated with an increased risk of EPS and hyperprolactinemia, and the potential risk could be as high as that induced by haloperidol and amisulpride, respectively. Additionally, our study provides grounds for future investigations into the associations between sulpiride and the increased use of additional drugs for managing adverse effects, including stomatological, dermatological, and musculoskeletal or joint side effects, constipation, and pneumonia.
Highlights
The number of currently available antipsychotic medications, each with unique effectiveness and side effect profile, has made it feasible to individualize regimen to achieve optimal antipsychotic therapy and this has become standard practice for patients with schizophrenia [1]
The prescription sequence symmetry analysis (PSSA) found that sulpiride was associated with extrapyramidal syndromes (EPS) and hyperprolactinemia (12.04; 1.59–91.2)
EPS caused by haloperidol has a magnitude of 1.99 when analyzed with PSSA, and hyperprolactinemia caused by amisulpride has a magnitude of 8.05, respectively
Summary
The number of currently available antipsychotic medications, each with unique effectiveness and side effect profile, has made it feasible to individualize regimen to achieve optimal antipsychotic therapy and this has become standard practice for patients with schizophrenia [1]. Optimal antipsychotic therapy requires a psychiatrist to select a viable regimen based on global assessment of individual patients by weighing safety and tolerability of drugs against their efficacy [1,2]. A comparative effectiveness study showed that sulpiride, a relatively affordable typical antipsychotic (TA), was significantly more effective than haloperidol, risperidone and olanzapine in treating schizophrenia, potentially providing a cost-effective alternative to the more expensive AAs and curbing the high and rising cost of antipsychotic treatment [5]. There were no data for many important outcomes concerning adverse effects of sulpiride
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