Pimozide

Indications
 Oral
Schizophrenia
Adult: Initially, 2 mg daily adjusted according to response by increments of 2-4 mg at intervals of not <1 wk. Max dose: 20 mg/day.
Child: 12-18 yr: Initial dose: 1 mg daily.
Oral
Monosymptomatic hypochondria
Adult: Initially, 4 mg daily adjusted according to response by increments of 2-4 mg at intervals of not <1 wk. Max dose: 16 mg/day.
Elderly: Half the usual initial dose.
Oral
Paranoid states
Adult: Initially, 4 mg daily adjusted according to response by increments of 2-4 mg at intervals of not <1 wk. Max dose: 16 mg/day.
Elderly: Half the usual initial dose.
Oral
Tourette's syndrome
Adult: Initially, 1-2 mg or 200 mcg/kg daily. Max dose: 10 mg/day.
Child: >12 yr: initial dose: 50 mcg/kg.

Special Populations: Reduce dose by ½ in elderly patients.
Contraindications
 Prolonged QT interval, family history of congenital QT prolongation, history of cardiac arrhythmias.
Warnings / Precautions
 Parkinson's syndrome; epilepsy, pregnancy, lactation; hepatic or renal impairment; monitor ECG before and during treatment; review the need for continuing treatment if repolarisation changes occur. Monitor cardiac function in patients taking >16 mg daily. Electrolytes disturbances such as hypomagnesaemia or hypokalaemia may increase risk of cardiotoxicity.
Adverse Reactions
 Extrapyramidal reactions, insomnia, drowsiness, dizziness. ECG changes, dry mouth, constipation, urinary difficulty and blurred vision.
Potentially Fatal: Neuroleptic malignant syndrome.
Drug Interactions
 Propranolol and cimetidine decrease hepatic metabolism and increase efficacy and toxicity. Concurrent use with SSRIs may increase risk of extrapyramidal adverse effects and potentially fatal torsades de pointes arrhythmias.
Potentially Fatal: Potentiates other CNS depressants eg, alcohol and benzodiazepines. Increased risk of arrhythmias due to prolonged QT interval with TCAs, terfenadine, astemizole, antimalarial and cisapride. Concurrent use with inhibitors of CYP3A4 or CYP2D6 may lead to increased plasma concentrations leading to cardiac arrhythmias. Imatinib may also raise the plasma concentrations of pimozide. Avoid use with drugs that cause electrolyte disturbances eg, diuretics.
See Below for More pimozide Drug Interactions
Food Interactions
 Concurrent use with grapefruit juice may increase the blood concentrations of pimozide.
Mechanism of Actions
 Pimozide is a long-acting antipsychotic structurally similar to butyrophenones which blocks dopaminergic receptors in the CNS. It also exhibits some calcium-blocking activity.
Absorption: >50% absorbed (oral); peak plasma levels after 4-12 hr.
Metabolism: Extensively hepatic via N-dealkylation.
Excretion: Urine and faeces (as unchanged drug and metabolites).
Administration
 May be taken with or without food.
ATC Classification
 N05AG02 - pimozide ; Belongs to the class of diphenylbutylpiperidine derivatives antipsychotics.
Available As
  • Pimozide 10 mg
  • Pimozide 2 mg
  • Pimozide 4 mg

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