Solian (amisulpride) is an atypical antipsychotic medication indicated for the treatment of schizophrenia in adults. It functions as a selective dopamine D2 and D3 receptor antagonist, with a distinct pharmacological profile that targets both positive and negative symptoms of schizophrenia. Clinical evidence supports its efficacy in acute episodes and maintenance therapy, offering a favorable side effect profile for many patients. Its dosage-dependent action allows for tailored therapeutic approaches, making it a versatile option in psychiatric care.

Features

• Active ingredient: Amisulpride
• Available in 50 mg, 100 mg, 200 mg, and 400 mg film-coated tablets
• Selective dopamine D2/D3 receptor antagonist
• Low affinity for serotonin, adrenergic, histaminic, and cholinergic receptors
• Oral administration with high bioavailability (~77%)
• Linear pharmacokinetics with dose proportionality
• Elimination half-life of approximately 12 hours
• Primarily renal excretion; dosage adjustment required in renal impairment

Benefits

• Effectively reduces positive symptoms such as hallucinations and delusions
• Improves negative symptoms including social withdrawal and apathy
• Lower incidence of extrapyramidal symptoms compared to typical antipsychotics
• Minimal weight gain and metabolic disturbances relative to other atypicals
• Flexible dosing allows for personalized treatment regimens
• Generally well-tolerated with a manageable side effect profile

Common use

Solian is primarily prescribed for the treatment of schizophrenia in adults. It is effective in managing both acute psychotic episodes and maintaining long-term symptom control. Its action on negative symptoms—often less responsive to conventional antipsychotics—makes it particularly valuable in cases where apathy, emotional blunting, or social withdrawal are prominent. Off-label uses may include other psychotic disorders, though such applications require careful clinical judgment and are not formally approved.

Dosage and direction

Dosage must be individualized based on symptom profile, patient response, and tolerability. For positive symptoms, the recommended dose is 400–800 mg/day, administered in two divided doses. Doses exceeding 400 mg/day do not generally show increased efficacy but may elevate side effect risk. For predominant negative symptoms, lower doses of 50–300 mg/day are often effective. Tablets should be swallowed whole with water, preferably before meals. Dosage adjustment is necessary in patients with renal impairment: reduce by 50% for creatinine clearance 30–60 mL/min and by 75% for clearance below 30 mL/min.

Precautions

Use with caution in patients with cardiovascular disease, seizure disorders, or Parkinson’s disease. Regular monitoring of electrolyte levels is advised due to the risk of hyponatremia. Solian may cause sedation; patients should avoid driving or operating machinery until response is established. Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of mortality. Pregnancy and lactation require careful risk-benefit assessment; use only if clearly needed.

Contraindications

Hypersensitivity to amisulpride or any excipients; pheochromocytoma; prolactin-dependent tumors; concomitant use with levodopa; severe renal impairment (creatinine clearance <10 mL/min). Solian is contraindicated in children and adolescents under 15 years of age.

Possible side effects

Common (≥1/10): insomnia, anxiety, agitation; hyperprolactinemia (may manifest as galactorrhea, gynecomastia, amenorrhea); weight gain.
Uncommon (≥1/1,000 to <1/100): extrapyramidal symptoms (akathisia, dystonia, tremor), sedation, hypotension, constipation, nausea, vomiting.
Rare (<1/1,000): QT prolongation, torsades de pointes, neuroleptic malignant syndrome, seizures, allergic reactions.
Side effects are often dose-dependent and may necessitate dosage adjustment or discontinuation.

Drug interaction

Concomitant use with other CNS depressants (e.g., alcohol, benzodiazepines) may enhance sedative effects. Avoid combination with drugs known to prolong QT interval (e.g., certain antiarrhythmics, macrolides, fluoroquinolones). Levodopa and dopamine agonists may antagonize Solian’s effect. Caution with drugs that cause electrolyte imbalance (e.g., diuretics) due to increased arrhythmia risk. Amisulpride is minimally metabolized by CYP450 enzymes; interactions via this pathway are unlikely.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one.

Overdose

Symptoms may include severe sedation, hypotension, extrapyramidal symptoms, and QT prolongation. Management is supportive: gastric lavage if ingestion was recent, activated charcoal, and ECG monitoring. There is no specific antidote. Treatment should focus on symptom management, particularly cardiovascular support and monitoring for arrhythmias.

Storage

Store below 30°C (86°F) in the original packaging to protect from light and moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for diagnosis, treatment decisions, and individualized dosing. Do not discontinue or alter medication without medical supervision.

Reviews

Clinical studies and post-marketing surveillance indicate that Solian is effective and generally well-tolerated. Patients and clinicians often report satisfactory control of both positive and negative schizophrenia symptoms, with a lower burden of metabolic side effects compared to some other antipsychotics. Hyperprolactinemia remains a notable concern but is often manageable with dose adjustment. Long-term adherence appears favorable due to its tolerability profile.