Pimozide

Pimozide Brand Name– Orap

What is Pimozide

Pimozide is a high potency conventional antipsychotic that is most recognized for its use in delusions of parasitosis and Tourette’s syndrome.

Although pimozide is generally considered as effective as other antipsychotics, most clinicians reserve it as an alternative primarily because of its cardiotoxic effects, including the potential for QT prolongation and torsade de pointes (TdP) compared to other agents in its class.

In addition, significant drug interactions limit the usefulness of this drug. The labeling of pimozide has been revised to include critical drug interactions with certain cytochrome P450 inhibitors that have resulted in sudden death.

Pimozide should not be used with other medications that are known to prolong the QT interval.

The use of pimozide should be reserved for the treatment of motor and phonic tics in those with Tourette’s syndrome who have failed to respond to standard treatment.

This agent is not routinely recommended for the treatment of schizophrenia because safer and equally efficacious medications are available.

The American Academy of Neurology (AAN) practice guideline states that pimozide is possibly more likely than placebo to reduce tic severity in those with Tourette’s syndrome or chronic tic disorders; however, there is insufficient evidence to determine the efficacy of pimozide relative to other antipsychotics used to treat tics.

Due to the risk for drug-induced movement disorders, QT prolongation, and elevated prolactin levels, the benefits of pimozide treatment should outweigh the risk for the individual patient.

The AAN recommends that patients be monitored throughout therapy, including ECG and QTc interval measurements before and after starting pimozide and counseled regarding adverse effects. Use the lowest effective dose for the individual.

A gradual taper over weeks to months is recommended during pimozide discontinuation to avoid withdrawal dyskinesias

Indications

• delusions of parasitosis
• schizophrenia
• Tourette’s syndrome

For the treatment of Tourette’s syndrome or chronic tic disorders† not responding to standard therapy

Side Effects

1. agranulocytosis
2. akathisia
3. amenorrhea
4. anorexia
5. aplastic anemia
6. appetite stimulation
7. asthenia
8. blurred vision
9. bradycardia
10. breast enlargement
11. cataracts
12. chest pain (unspecified)
13. constipation
14. diarrhea
15. dizziness
16. drowsiness
17. dysarthria
18. dysgeusia
19. dyskinesia
20. dysphagia
21. dystonic reaction
22. ejaculation dysfunction
23. eosinophilia
24. fever
25. galactorrhea
26. gingival hyperplasia
27. gynecomastia
28. headache
29. hemolytic anemia
30. hyperhidrosis
31. hyperkinesis
32. hyperprolactinemia
33. hypersalivation
34. hypertension
35. hyperthermia
36. hyponatremia
37. hypotension
38. hypothermia
39. impotence (erectile dysfunction)
40. increased urinary frequency
41. infertility
42. leukopenia
43. libido decrease
44. mastalgia
45. menstrual irregularity
46. myalgia
47. nausea
48. neuroleptic malignant syndrome
49. neutropenia
50. nocturia
51. orthostatic hypotension
52. palpitations
53. pancytopenia
54. photophobia
55. polydipsia
56. priapism
57. pseudoparkinsonism
58. pulmonary embolism
59. purpura
60. QT prolongation
61. rash
62. seizures
63. SIADH
64. sinus tachycardia
65. skin irritation
66. syncope
67. tardive dyskinesia
68. thrombocytopenia
69. thromboembolism
70. torsade de pointes
71. torticollis
72. tremor
73. urinary retention
74. visual impairment
75. vomiting
76. water intoxication
77. weight gain
78. weight loss
79. xerostomia

Monitoring Parameters

• AIMS assessment
• blood glucose
• CBC with differential
• ECG
• serum prolactin
• weight

Contraindications

• abrupt discontinuation
• agranulocytosis
• ambient temperature increase
• anticholinergic medications
• apheresis
• AV block
• bradycardia
• breast cancer
• breast-feeding
• cardiac arrhythmias
• cardiomyopathy
• celiac disease
• children
• CNS depression
• coadministration with other CNS depressants
• coma
• dehydration
• dementia
• driving or operating machinery
• dysphagia
• ethanol ingestion
• females
• fever
• geriatric
• glaucoma
• heart failure
• hematological disease
• hepatic disease
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hyperprolactinemia
• hyperthermia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypotension
• hypothermia
• hypothyroidism
• ileus
• infants
• infertility
• leukopenia
• long QT syndrome
• myocardial infarction
• neonates
• neutropenia
• orthostatic hypotension
• Parkinson’s disease
• pheochromocytoma
• poor metabolizers
• pregnancy
• pregnancy testing
• priapism
• prostatic hypertrophy
• QT prolongation
• renal disease
• renal impairment
• rheumatoid arthritis
• seizure disorder
• seizures
• sickle cell disease
• sleep deprivation
• strenuous exercise
• stroke
• systemic lupus erythematosus (SLE)
• tardive dyskinesia
• thromboembolism
• tics
• torsade de pointes
• urinary retention

Interactions

• Abarelix
• Abiraterone
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
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