Brief Answer:
Consultation

Detailed Answer:
Hello XXXXXXX and as always thank you for raising such an interesting question.

Sulpiride is a benzamine atypical neuroleptic, of which there are only two others - sultopride, and what you are currently taking, Solian. In that respect, sulpiride would be a fine choice, as you seem to metabolize Solian in a way that is not detrimental to you (as iloperidone was detrimental to you via its 3A4 interactions).

For your consideration, I will mention that we rarely use benzamine atypical neuroleptics in the United States. I am familiar with these medications and their uses because of my extensive experience working in psychiatry in other countries as a consultant -- however, they are not approved for use in the USA.

The reason for this is their side effect profile can be harsher than other drugs. In the US we prefer to use agents such as olanzapine, risperidone, quetiapine, lurasidone, iloperidone, and aripiprazole (Abilify), because they are seen as less damaging to the heart and less likely to cause extrapyramidal symptoms than drugs like Solian, Sulpiride, and Sertindole .

This is why after considering your medication history very carefully I suggested Abilify for you. HOWEVER -- I always use drugs that work for each INDIVIDUAL patient, and it seems like the benzamine atypical neuroleptics have worked for you, so the selection of Sulpiride as a backup - Solian not work is perfectly appropriate, and I would agree with your psychiatrist on this choice.

Please let me know if this makes sense, and if you have any follow-up questions on this issue.

Dr. Sheppe

XXXX

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Brief Answer:
Followup

Detailed Answer:
Another medication that is very similar to Abilify is Latuda (lurasidone), so if Abilify caused you problems before, Latuda might be a more appropriate suggestion. Though as I say, I do agree with the selection of Sulpiride as a backup given its similarity to Solian.

Sulpiride achieves its effects primarily through D2 blockade. Keep in mind that while Solian has partial D2 agonist effects at low doses, it (like most antipsychotics) also achieves its primary antipsychotic effects at higher doses through D2 blockage. So these drugs are all very similar in that regard (D2 blockade). However, as you point out, Sulpiride is different in that it lacks prominent serotonergic action. I actually think the serotonergic effects of Solian are helping you, as this serves both antidepressant and anti-OCD roles. I think Solian will ultimately be the right choice for you, but Sulpiride would be a reasonable backup, with several others to be considered if you want to avoid some of the stronger side effects, others like Latuda.

Does this make sense? I hope I was clear.

Dr. Sheppe

XXXX

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