Sulpiride

Introduced 1968

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Schizophrenia and other psychotic disordersDepressive disorders (low-dose)Functional dyspepsiaVertigo

Mechanism

Selectively antagonizes dopamine D2 and D3 receptors, reducing dopaminergic neurotransmission in mesolimbic pathways (antipsychotic effect) and modulating activity in other brain regions and the gastrointestinal tract.

Dosing

Adult Dosing

oral: Schizophrenia: 400–800 mg/day in divided doses, up to 1600 mg/day. Depression/functional dyspepsia: 50–150 mg/day in divided doses.

Dosage Forms

Tablets: 50 mg, 100 mg, 200 mg
Capsules: 50 mg, 100 mg
Injection (IM): 100 mg/2 mL

Onset Duration

Psychiatric symptom improvement may be observed within 1–2 weeks; gastrointestinal benefits may occur within days.

Adverse Effects

Common Side Effects

• somnolence

• insomnia

• extrapyramidal symptoms

• hyperprolactinemia

• weight gain

⚠️ Serious Side Effects

neuroleptic malignant syndrome
tardive dyskinesia
QT prolongation

Warnings

Critical Safety Information

→May cause hyperprolactinemia; monitor with prolonged use
→Use caution in patients with cardiovascular disease or risk factors for QT prolongation
→Increased mortality in elderly patients with dementia-related psychosis
→Avoid abrupt discontinuation to reduce relapse risk

Interactions

With: Levodopa

Risk: Reduced antiparkinsonian effect

Action: Avoid combination

With: Alcohol and CNS depressants

Risk: Additive sedation

Action: Avoid or monitor closely

With: QT-prolonging drugs

Risk: Additive QT prolongation

Action: Avoid combination

Monitoring

Psychiatric status and symptom control
Extrapyramidal symptoms
Weight, BMI, and metabolic labs
Prolactin levels

Special Populations

👶Pregnancy

Use only if benefits outweigh potential risks; risk of neonatal extrapyramidal or withdrawal symptoms if used late in pregnancy.

🤱Breastfeeding

Excreted in breast milk; monitor infant for sedation or feeding issues if use is unavoidable.

👴Older Adults (65+)

Increased sensitivity to hypotension and sedation; start with lower doses.

Tapering

Gradually reduce dose over 1–2 weeks to minimize withdrawal symptoms or relapse.

Clinical Notes

Low doses may have antidepressant and prokinetic effects
Not approved in the United States; available in select countries
Prolactin elevation is more prominent compared to many other antipsychotics

This medication information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication. Never take medication without a prescription from a licensed healthcare provider.

Interested in this treatment?

This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

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Sulpiride

Introduced 1968

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Schizophrenia and other psychotic disordersDepressive disorders (low-dose)Functional dyspepsiaVertigo

Mechanism

Dosing

Adult Dosing

oral: Schizophrenia: 400–800 mg/day in divided doses, up to 1600 mg/day. Depression/functional dyspepsia: 50–150 mg/day in divided doses.

Dosage Forms

Tablets: 50 mg, 100 mg, 200 mg
Capsules: 50 mg, 100 mg
Injection (IM): 100 mg/2 mL

Onset Duration

Psychiatric symptom improvement may be observed within 1–2 weeks; gastrointestinal benefits may occur within days.

Adverse Effects

Common Side Effects

• somnolence

• insomnia

• extrapyramidal symptoms

• hyperprolactinemia

• weight gain

⚠️ Serious Side Effects

neuroleptic malignant syndrome
tardive dyskinesia
QT prolongation

Warnings

Critical Safety Information

→May cause hyperprolactinemia; monitor with prolonged use
→Use caution in patients with cardiovascular disease or risk factors for QT prolongation
→Increased mortality in elderly patients with dementia-related psychosis
→Avoid abrupt discontinuation to reduce relapse risk

Interactions

With: Levodopa

Risk: Reduced antiparkinsonian effect

Action: Avoid combination

With: Alcohol and CNS depressants

Risk: Additive sedation

Action: Avoid or monitor closely

With: QT-prolonging drugs

Risk: Additive QT prolongation

Action: Avoid combination

Monitoring

Psychiatric status and symptom control
Extrapyramidal symptoms
Weight, BMI, and metabolic labs
Prolactin levels

Special Populations

👶Pregnancy

Use only if benefits outweigh potential risks; risk of neonatal extrapyramidal or withdrawal symptoms if used late in pregnancy.

🤱Breastfeeding

Excreted in breast milk; monitor infant for sedation or feeding issues if use is unavoidable.

👴Older Adults (65+)

Increased sensitivity to hypotension and sedation; start with lower doses.

Tapering

Gradually reduce dose over 1–2 weeks to minimize withdrawal symptoms or relapse.

Clinical Notes

Low doses may have antidepressant and prokinetic effects
Not approved in the United States; available in select countries
Prolactin elevation is more prominent compared to many other antipsychotics

Interested in this treatment?

This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

Locate Psychiatrists