Pimozide Uses/Indications Adverse effects- DrugsAce

Classes

DEA Class; Rx

Common Brand Names; Orap

Antipsychotics, 1st Generation;

High potency oral antipsychotic; associated with QT prolongation and cardiac arrhythmias; many contraindicated drug interactions
Reserved for use for motor and phonic tics of Tourette’s syndrome refractory to standard treatment
As with all antipsychotics, increased mortality risk in elderly patients treated for dementia-related psychosis

Indications

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

For the treatment of delusions of parasitosis not responding to standard therapy.

For the treatment of schizophrenia not responding to standard therapy.

Contraindications

Documented hypersensitivity

CNS depression (including coma), neuroleptic malignant syndrome (NMS), poorly controlled seizure disorder

Use as first-line treatment

Tics not associated with Tourette’s

Prolongs QT interval: concurrent QT-prolonging drugs or congenital long QT patients

Concomitant CYP3A4 or CYP2D6 inhibitors

Adverse Effects

Akinesia (40%)
Drowsiness (35%)
EPS (10-15%)
Sedation (70%)
Speech disorder (10-15%)
Visual disturbance (20%)
Dry mouth (25%)
Constipation (20%)
Impotence (10-15%)
Appetite increase
Thirst increase
Dizziness
Drug-induced tardive dystonia
Nervousness
Photosensitivity
Taste change
Orthostatic hypotension
Diminished sweating
Nasal congestion
Diarrhea
Urinary retention
Retinitis pigmentosa
Ineffective thermoregulation
Heatstroke or hypothermia (rare)
Neuroleptic malignant syndrome (rare)
Seizure (rare)
Prolonged QT interval
Torsades de pointes
Obstipation (rare)
Paralytic ileus (rare)
Agranulocytosis (rare)

Warnings

FDA Warning regarding off-label use for dementia in elderly

Avoid grapefruit juice

Risk of EPS & NMS

Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC) and history of drug-induced leukopenia/neutropenia

If history of clinically significant low WBC or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of a clinically significant decline <1000/mm³ in WBC in absence of other causative factors and continue monitoring WBC until recovery

Pregnancy and Lactation

Pregnancy Category: C

Neonates exposed to antipsychotic drugs during the 3rd trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery

These complications vary in severity; in some cases, symptoms have been self-limited, while in other cases neonates have required intensive care unit support and prolonged hospitalization

Lactation: unknown, avoid

Maximum Dosage

Adults

0.2 mg/kg/day PO or 10 mg/day PO, whichever is less.

Geriatric

0.2 mg/kg/day PO or 10 mg/day PO, whichever is less.

Adolescents

0.2 mg/kg/day PO or 10 mg/day PO, whichever is less.

Children

8 to 12 years: Do not exceed 0.2 mg/kg/day or 10 mg/day PO, whichever is less. Published data suggest a maximum of 6 mg/day PO or 0.2 mg/kg/day PO, whichever is less, for children less than 12 years old.
Less than 8 years: Safety and efficacy have not been established.

Infants

Not indicated.

How supplied

Pimozide

tablets