Amisulpride 200 mg at Night: Clinical Uses
Amisulpride 200 mg taken at night is primarily used for treating schizophrenia with predominantly positive symptoms, and may also be used as augmentation therapy with clozapine in treatment-resistant cases. 1, 2
Primary Indication: Schizophrenia with Positive Symptoms
For patients with acute exacerbations of schizophrenia or predominantly positive symptoms, amisulpride 200-1200 mg/day is the recommended dosage range, with 400-800 mg/day being optimal for most patients. 1, 2 A 200 mg nightly dose falls at the lower end of this therapeutic range and may be appropriate for:
- Patients requiring lower doses due to tolerability concerns 1
- Maintenance therapy after initial stabilization at higher doses 2
- Patients transitioning from other antipsychotics 3
The plasma concentration threshold for clinical response is approximately 200 ng/ml, which corresponds to doses around 400 mg/day, suggesting that 200 mg may be subtherapeutic for acute symptoms but potentially adequate for maintenance. 4
Secondary Use: Clozapine Augmentation
Amisulpride 200-800 mg/day added to clozapine has demonstrated significant efficacy in treatment-resistant schizophrenia, with 71-86% of patients showing clinical response. 3 In three prospective studies, this combination reduced:
- Brief Psychiatric Rating Scale scores by 33-35% 3
- Clinical Global Impression-Severity scores by 31% 3
- Positive and Negative Syndrome Scale scores by 22% 3
A 200 mg nightly dose represents the lower end of the augmentation range and may be used as a starting dose before titration. 3
Alternative Use: Negative Symptoms (Lower Doses)
While 200 mg exceeds the typical range for treating predominantly negative symptoms (50-300 mg/day), it could theoretically be used at the upper end of this spectrum. 1, 2 However, for predominantly negative symptoms, lower doses of 50-300 mg/day are specifically recommended, as amisulpride at these doses preferentially blocks presynaptic dopamine receptors to enhance dopaminergic transmission. 1
Dosing Considerations and Timing
The recommended starting dose for acute psychotic exacerbations is 800 mg/day, 400-800 mg/day for predominantly positive symptoms, and 100-300 mg/day for predominantly negative symptoms. 3 Taking 200 mg at night may be chosen for:
- Convenience and adherence (once-daily dosing) 3
- Minimizing daytime sedation 5
- Gradual dose escalation strategy 3
Safety Profile at This Dose
At 200 mg/day, amisulpride is generally well-tolerated with a safety profile similar to placebo for doses ≤300 mg/day. 1 However, extrapyramidal symptoms are more reliably predicted by plasma levels above 320 ng/ml than by dose alone, and 200 mg/day typically produces plasma levels below this threshold. 4
Common side effects at this dose include:
- Increased prolactin levels (occurs across all doses) 2
- Mild weight gain (less than risperidone or olanzapine) 2
- Potential amenorrhea in approximately 4% of women 2
Important Caveats
Amisulpride 200 mg at night may be suboptimal as monotherapy for acute schizophrenia with prominent positive symptoms, as the optimal response range is 400-800 mg/day with plasma levels of 200-500 ng/ml. 4 This dose is more appropriate for:
- Maintenance therapy after acute stabilization 2
- Augmentation of clozapine (as a starting dose) 3
- Patients requiring lower doses due to side effects or elderly patients 3
Cross-tapering over 4 weeks is preferred when switching to amisulpride from other antipsychotics, rather than abrupt cessation. 3