Amisulpiride- A SGA With An OHA Like Action?

BACKGROUND: Second generation antipsychotics are first line treatment of psychotic disorders and mood disorders with psychotic symptoms(as adjunct to mood agents). Atypical anti-psychotic drugs are known to cause varied metabolic side effects(1). But, amisulpiride being an SGA, is postulated to have glucose lowering action by overcoming insulin resistance and enhancing insulin secretion(2). CASE SERIES: In this case series, we describe 3 different case scenarios, where we bring to your notice three cases, where patients with psychosis and diabetes, who were started on Amisulpiride and did not take OHA under various scenarios, have shown improvement in the glycaemic control, as well. Thus, it is an interesting hypothesis to see if Amisulpiride having an OHA like action and if a trial of amisulpiride monotherapy can be given in patients with diabetes with psychotic disorders or mood disorders with psychotic symptoms for glycemic control, before giving any OHA. DISCUSSION AND CONCLUSION: Amisulpride has been demonstrated to have anti-diabetec effect by increasing insulin secretion in rats(3).Novelty of our case series has been generating a hypothesis that Amisulpiride also has OHA like action in humans and it can be tried as standalone therapy for patients with psychotic symptoms and co-morbid diabetes.This hypothesis needs further research and systemized study with a well-designed RCT to substantiate it further. REFRENCES 1. Ravan, J. R., Thomas, N., Paul, T., Prasanna, S., Thomas, N., & Ramaswamy, D. (2017). The endocrine impact of long term risperidone therapy in Asian Indian patients. Open Journal of Psychiatry & Allied Sciences, 8(2), 107. doi:10.5958/2394-2061.2017.00003.9. 2. Peuskens J, De Hert M, Mortimer A; SOLIANOL Study Group. Metabolic control in patients with schizophrenia treated with amisulpride or olanzapine. Int Clin Psychopharmacol. 2007 May;22(3):145-52. doi: 10.1097/YIC.0b013e3280148c29. PMID: 17414740. 3. Roix JJ, DeCrescenzo GA, Cheung PH, Ciallella JR, Sulpice T, Saha S, Halse R. Effect of the antipsychotic agent amisulpride on glucose lowering and insulin secretion. Diabetes Obes Metab. 2012 Apr;14(4):329-34. doi: 10.1111/j.1463-1326.2011.01529.x. Epub 2011 Dec 27. PMID: 22059694.