Sulpride in GTS: A Brief Literature Summary

It turns out that sulpride has been around for quite a long time; it has been occasionally used to treat schizophrenia since the 1960s with fewer side effects than halperodol, [1] but its use is not generally accepted because there are so many better agents around. All of the usual extrapyramidal and autonomic side-effects, including tardive dyskinesia and neuroleptic malignant syndrome. The incidence of these adverse reactions has not been clearly established.[2] Technically, sulpiride is a substituted benzamide with selective dopaminergic blocking activity. Early pharmacology reports hypothesized that sulpiride was selective for dopamine (D)2 receptors only, but sulpiride also blocks D3 and D4 receptors. Sulpiride does not block D1, adrenergic, cholinergic, gamma-aminobutyric acid-ergic, histaminergic, or serotonergic [this one is controversial] receptors to an appreciable extent. Daily doses in schizophrenia patients reported in clinical studies range from 100 to 3200 mg

I can only find 6 references in the literature to the use of sulpiride in TS. The most significant is a clinical study reported in 1990 which shows that it had beneficial effects in 37 of 63 TS patients, with fewer side effects than Haldol.[3] Another recent study [4] examined the effects of various anti-TS meds on drug-induce head shaking in animals, and concluded that the effectiveness of these medications is related to their affinity to the 5HT2A serotonin receptor, in contrast to earlier studies. Two other references are not in English and are not abstracted in MEDLINE, but appear to be single-case studies.[5, 6] Finally, there is a case study[7] of a single 14-year old with TS and OCD treated with sulpiride and luvox unsuccessfully.

References

[1] Munk-Andersen E, Behnke K, Heltberg J, Nielsen H, Gerlach J. Sulpiride versus haloperidol, a clinical trial in schizophrenia. A preliminary report. Acta Psychiatr Scand Suppl 1984 311: 31-41

[2] Caley CF, Weber SS. Sulpiride: an antipsychotic with selective dopaminergic antagonist properties. Ann Pharmacother 1995 Feb 29:2 152-60

[3] Robertson MM, Schnieden V, Lees AJ. Management of Gilles de la Tourette syndrome using sulpiride. Clin Neuropharmacol 1990 Jun 13:3 229-35

[4] Dursun SM, Handley SL. Similarities in the pharmacology of spontaneous and DOI-induced head-shakes suggest 5HT2A receptors are active under physiological conditions. Psychopharmacology (Berl) 1996 Nov 128:2 198-205

[5] Trillet M, Moreau T, Daléry J, de Villard R, Aimard G. [Treatment of Gilles de la Tourette's disease with amisulpride (letter)] Presse Med 1990 Feb 3 19:4 175

[6] Yvonneau M, Bezard P. [Apropos of a case of Gilles de la Tourette's disease blocked by sulpiride. Psycho-biological study]. Encephale 1970 Sep-Oct 59:5 439-59

[7] Fennig S, Fennig SN, Pato M, Weitzman, A. Emergence of symptoms of Tourette's syndrome during fluvoxamine treatment of obsessive-compulsive disorder. Br J Psychiatry 1994 Jun:6 839-41