title: Detecting potential adverse reactions of sulpiride in schizophrenic patients by prescription sequence symmetry analysis.
abstract: OBJECTIVE
  Previous studies have demonstrated sulpiride to be significantly more effective than haloperidol, risperidone and olanzapine in schizophrenic treatment; however, only limited information is available on the potential risks associated with sulpiride treatment. This study attempts to provide information on the potential risks of sulpiride treatment of schizophrenia, especially with regard to unexpected adverse effects.
  
  
  METHODS
  Patients with schizophrenia aged 18 and older, newly prescribed with a single antipsychotic medication from the National Health Insurance Research Database of Taiwan in the period from 2003 to 2010 were included. A within-subject comparison method, prescription sequence symmetry analysis (PSSA) was employed to efficiently identify potential causal relationships while controlling for potential selection bias.
  
  
  RESULTS
  A total of 5,750 patients, with a mean age of 39, approximately half of whom were male, constituted the study cohort. The PSSA found that sulpiride was associated with EPS (adjusted SR, 1.73; 95% CI, 1.46-2.06) and hyperprolactinemia (12.04; 1.59-91.2). In comparison, EPS caused by haloperidol has a magnitude of 1.99 when analyzed with PSSA, and hyperprolactinemia caused by amisulpride has a magnitude of 8.05, respectively. Another finding was the unexpected increase in the use of stomatological corticosteroids, emollient laxatives, dermatological preparations of corticosteroids, quinolone antibacterials, and topical products for joint and muscular pain, after initiation of sulpiride treatment.
  
  
  CONCLUSIONS
  We found sulpiride to be associated with an increased risk of EPS and hyperprolactinemia, and the potential risk could be as high as that induced by haloperidol and amisulpride, respectively. Additionally, our study provides grounds for future investigations into the associations between sulpiride and the increased use of additional drugs for managing adverse effects, including stomatological, dermatological, and musculoskeletal or joint side effects, constipation, and pneumonia.
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng-Kung University, Tainan, Taiwan.
authors.forename: Edward Chia-Cheng
authors.initials: EC
authors.lastname: Lai
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng-Kung University, Tainan, Taiwan ; Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan.
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng-Kung University, Tainan, Taiwan ; Health Outcome Research Center, National Cheng-Kung University, Tainan, Taiwan.
authors.forename: Yea-Huei
authors.initials: YH
authors.lastname: Kao Yang
authors.affiliation: Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors.forename: Swu-Jane
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077582:Amisulpride; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology*; D013469:Sulpiride / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D013469:Sulpiride; D000077582:Amisulpride