Asymptomatic Bradycardia Associated with Amisulpride

Abstract

Well-known adverse effects of amisulpride include nausea, insomnia or tiredness, gastrointestinal, extrapyramidal and endocrine symptoms. Cardiac disorders, however, appear to be an extremely rare complication of the drug. Only a few case reports on this complication have been published so far, which deal with QT prolongation, hypotension, hypertension and palpitations. Bradycardia has not yet been mentioned. Here, we will report on a case of asymptomatic bradycardia that developed subsequent to therapeutic doses of amisulpride in a 25-year-old male patient with chronic paranoid-hallucinatory schizophrenia. The patient had been rehospitalized for an acute exacerbation of the psychosis. When the patient failed to respond at the beginning of hospitalization, the treatment was changed from clozapine to amisulpride. After a complete switchover to amisulpride, the patient's ECG showed sinus bradycardia and QT prolongation. When the daily dose of amisulpride was reduced from 800 mg/d to 600 mg/d, the patient's ECG quickly normalized (including blood pressure and pulse rate) within a few days. The patient did not report any cardiovascular-related complaints. Since the cardiovascular-specific diagnostics did not yield any indicative results, bradycardia may be a rare complication of amisulpride treatment.

Two cases of amisulpride overdose: A cause for prolonged QT syndrome

“…Amisulpride is known to cause prolongation of the QT interval at normal doses and in overdose 4,5 . Torsades de pointes has not been reported following overdose.…”

Amisulpride-Associated QTc Prolongation

“…Reports of cardiac adverse effects of therapeutic dosages of amisulpride are rare. Bradycardia and QT prolongation up to 480 ms with amisulpride 800 mg/d has been reported, with subsequent reduction in QT on dose reduction to 600 mg 6 . In another report, the authors reported QT prolongation up to 454 ms and torsades de pointes with low dose amisulpride of 100 mg/d with additional complications of ventricular fibrillation and cardiac arrest.…”

Ventricular ectopics during crossover of atypical antipsychotics

“…In all available literature, we found only one case report of asymptomatic bradyarrhythmia following administration of amisulpride [3]. Given the extent of worldwide use of atypical antipsychotic agents, it appears that cardiac arrhythmias are a rare complication [4,5], but we suggest cardiac monitoring is warranted during crossover titration, especially in patients with cardiac malfunction.…”