Antipsychotics are generally classified into typical (or first generation) and atypical (or second generation). In this article we will discuss tiapride, an atypical antipsychotic that selectively blocks the dopamine receptors D₂ and D₃ in the brain. Let’s see what its characteristics are.

Tiaprida: characteristics

Tiapride is an atypical or second generation antipsychotic . It is an antidopaminergic (decreases the concentration of dopamine in the brain), belonging to the benzamide group.

On the other hand, this drug has antipsychotic, low potency and antiemetic (prevents vomiting) action.

In addition, stimulates the production of prolactin, has a mild sedative and alpha-adrenergic blocking action . On the other hand, its anticholinergic action is almost nil.

Mechanism of action

Tiapride is an atypical neuroleptic that selectively blocks dopamine receptors D2 and D3 ; as a result, the concentration of dopamine in the brain decreases

Indications

We know that antipsychotics are generally used to treat the positive (and to a lesser extent the negative) symptoms of different types of psychosis . However, some antipsychotics are also used to treat other clinical pictures or illnesses, as we will see.

Tiapride is indicated for severe behavioural disorders in agitated and aggressive children who do not respond to other first-line treatment. It is also indicated in severe Huntington’s Disease , in patients who do not respond to first line treatment, as well as in cases of dysphemia and in Tourette’s Syndrome.

Contraindications

Tiapride is contraindicated in cases of hypersensitivity to it, in prolactin-dependent tumors (e.g. pituitary prolactinoma and breast cancer), in pheochromocytoma, in association with levodopa (a metabolic precursor of dopamine, indicated for treating Parkinson’s disease) or in combination with dopaminergic drugs.

On the other hand, there are a number of combinations not recommended when taking tiapride . These are:

  • Alcohol.
  • Levodopa (medication for the treatment of Parkinson’s).
  • Different levodopa dopamine agonists (amantadine, apomorphine, bromocriptine, entacapone, lysuride, pergolide, piribedil, pramipexole, ropinirole, selegiline) in patients with Parkinson’s disease.
  • Methadone (pain-relieving medication)
  • Medications that can induce heart rhythm disturbances (torsades de pointes)

Warnings and Cautions

Caution should be exercised (and the dose reduced) in patients with a history of epilepsy, in the elderly, children , and patients with risk factors for stroke.

On the other hand, tiapride is associated with a risk of producing severe ventricular arrhythmias . Tiapride should not be used in Parkinson’s disease, and treatment should be discontinued in the event of hyperthermia (increased body temperature above normal) of unknown origin due to the risk of neuroleptic malignant syndrome (NMS).

Pregnancy and lactation

As for the use of tiapride in pregnancy, animal studies have been conducted and no harmful effects have been found.

However, there is little clinical data on pregnant women, so tiapride should be used with caution . If used in the last phase of pregnancy, it can induce tachycardia, hyperexcitability, abdominal distension, meconium retardation and sedation in the neonate.

Regarding breastfeeding, animal studies have shown excretion of tiapride in breast milk; since no data are available regarding excretion of tiapride in human breast milk, breastfeeding is not recommended during tiapride treatment (or if breastfeeding, the use of tiapride is not recommended).

Side effects

The adverse reactions described from tiapride are: dizziness or vertigo, headache, tremor, increased muscle tone, slowing of movement , increased salivation, drowsiness, insomnia, agitation, indifference, hyperprolactinemia, asthenia/fatigue, involuntary movements.

In children there are no specific data for adverse reactions.

Bibliographic references:

  • Stahl, S.M. (2002). Essential Psychopharmacology. Neuroscientific bases and clinical applications. Barcelona: Ariel.
  • AGEMED Therapeutic Prescription Guide (2006). Technical Sheets (available at CIMA from the page http://www.aemps.es). Medimecum® (guide to drug therapy, 17th ed).
  • Villa, L.F. editor. (2011). Medimecum, a guide to drug therapy. 16th edition. Spain: Adis.