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pimozide / Orap^TM

ANTIPSYCHOTIC

HIGH RISK

Description: Pimozide is an oral antipsychotic agent that is chemically similar to haloperidol; it is not a phenothiazine. Pimozide is a specific antagonist of postsynaptic dopamine type 2 (DA) receptors although presynaptic receptors may also be blocked. It is used for the motor and phonic tics in patients with Tourette's syndrome who have failed to respond to standard therapy. Pimozide has high extrapyramidal effects, moderate sedative effects, and moderate anticholinergic effects compared with other phenothiazines. Elimination T« has been reported to range 55-154 hours. Pimozide was approved by the FDA in 1984.

Contraindications: simple tics; drug-induced motor or phonic tics; congenital long-QT syndrome; cardiac arrhythmias; concomitant use with drugs that prolong QT interval; CNS depression; coma; hypokalemia; hepatic dysfunction; renal dysfunction.

Drug Interactions: Cocaine: potential antagonism as pimozide is a dopamine receptor antagonist. Phenothiazines, tricyclic antidepressants, antiarrhythmic agents: Additive effect on prolongation of QT interval. CNS depressants (e.g., ethanol, opiates): Can lead to excessive sedation or CNS depression. Anticonvulsants: Pimozide can lower the seizure threshold, so adjustment of anticonvulsant therapy may be necessary. Adverse Reactions: ECG changes (QT prolongation, T-wave inversion, flattening, notching, U-waves); extrapyramidal effects; tardive dyskinesia; xerostomia; constipation; hypotension; sinus tachycardia; syncope; drowsiness.

Dosage: Initially, 1-2 mg PO per day in divided doses; increase dose at intervals of not less than every other day to a maximum maintenance dose of 0.2 mg/kg or 10 mg a day, whichever is less. Some clinicians recommend that dose adjustments should be made at intervals of 5-7 days due to the long T«. If the drug is to be discontinued, the dose should be gradually tapered.

The P-I-E-N-O Parkinsn's List Drug Database Index

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