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Amisulpride doses and plasma levels in different age groups of patients with schizophrenia or schizoaffective disorder

Department of Psychiatry, University of Mainz, Mainz, Germany; Clinic for Psychiatry and Psychotherapy, Marburg-Süd, Germany; Clinic for Psychiatry and Psychotherapy, Giessen, Germany

FX Eich

Sanofi-Aventis Deutschland GmbH, Berlin, Germany

B Regenbogen

Department of Psychiatry, University of Mainz, Mainz, Germany

J Sachse

Department of Psychiatry, University of Mainz, Mainz, Germany

S Härtter

Department of Psychiatry, University of Mainz, Mainz, Germany; Boehringer-Ingelheim, Biberach, Germany

C Hiemke

Department of Psychiatry, University of Mainz, Mainz, Germany

Abstract

Because of a unique pharmacodynamic profile, amisulpride seems appropriate for treatment of elderly patients with schizophrenia. In a large-scale naturalistic therapeutic drug monitoring study, daily amisulpride dose, trough and dose-corrected amisulpride plasma levels, co-medication, clinical effectiveness (CGI) and side effects (UKU) were compared between age groups in 395 patients with schizophrenia or schizoaffective disorder (46% women; mean age 39.1 ± 14.2 years, range 18–83 years) under amisulpride therapy. Mean amisulpride doses (574 ± 269 mg/day), plasma levels (304 ± 274 ng/mL), dose-corrected amisulpride plasma levels (C/D ratios, 0.52 ± 0.41 ng/mL:mg), clinical response (at least moderate improvement, 71.6%), and side effects (any side effect, 32.2%; extrapyramidal symptoms, 14.9%) were comparable between age groups (P > 0.25). At higher age, significantly more benzodiazepines (P = 0.04), non-benzodiazepine hypnotics (P = 0.004) and non-psychotropic medications (P < 0.0001) were prescribed. The naturalistic study showed higher C/D ratios in women (P = 0.019) and a slight increase of C/D ratios with age (P = 0.026), but no substantial age-dependent effects on amisulpride doses or plasma levels. In patients above 60 years, clinical response was associated with lower amisulpride plasma levels (P = 0.016) at comparable doses. Neither the age-dependent decrease of amisulpride clearance nor the significantly higher prevalence of co-morbidity and co-medication seem to be the reasons for definite clinical concerns against amisulpride treatment of elderly if contraindications are seriously taken.

Key Words: age • amisulpride • clinical treatment • plasma levels • schizophrenia

This version was published on May 1, 2009

Journal of Psychopharmacology, Vol. 23, No. 3, 278-286 (2009)
DOI: 10.1177/0269881108089806


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