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Pimozide

Pimozide is a typical antipsychotic medication primarily used to treat Tourette's syndrome, particularly for managing severe tics that interfere with daily functioning. It is also used for certain cases of chronic schizophrenia. Pimozide works by influencing the levels of specific neurotransmitters in the brain, especially dopamine, to help reduce the frequency and intensity of involuntary movements or vocalizations.



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Frequently Asked Questions

How long does it take for Pimozide to start working?
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It may take several days to weeks to see improvements in tics or other symptoms. Your healthcare provider will monitor your progress and adjust your dose as needed.

Can I stop taking Pimozide abruptly?
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No, stopping pimozide suddenly can lead to withdrawal symptoms or a worsening of tics. If you need to stop taking the medication, your healthcare provider will gradually reduce the dose.

Can I drink alcohol while taking Pimozide?
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It is best to avoid alcohol while taking pimozide, as it can increase drowsiness and other side effects.

What should I do if I miss a dose of Pimozide?
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If you miss a dose, take it as soon as you remember unless it is close to the time for your next dose. Do not double up on doses to make up for the missed one.

Is Pimozide safe for children?
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Yes, pimozide is approved for use in children with Tourette’s syndrome, but the dose must be carefully adjusted based on the child’s weight and response to treatment.

Comprehensive Drug Guide

How Does Pimozide Work?

Pimozide works by blocking dopamine receptors in the brain, particularly in areas involved in controlling movement and behavior. By reducing dopamine activity, pimozide helps to control motor tics and vocal tics in patients with Tourette’s syndrome and reduces symptoms of delusions or hallucinations in patients with schizophrenia.



Common Dosages

  • 1 mg tablets
  • 2 mg tablets

Typical Dosing

  • For Tourette's syndrome: The typical starting dose is 0.05 mg/kg/day, with gradual dose increases. The maximum daily dose is usually 10 mg/day in adults.
  • Dosage should be carefully adjusted based on individual response and tolerability.


Typical Dosing

FDA Approved Indications

  • Tourette's syndrome, specifically for the suppression of severe motor and vocal tics in patients who have not responded adequately to other medications.
  • Chronic schizophrenia (off-label).


Who Shouldn't Take Pimozide?

  • Congenital long QT syndrome
  • Severe cardiovascular disease
  • History of severe arrhythmias
  • Known hypersensitivity to pimozide
  • Hypokalemia or hypomagnesemia (as pimozide may prolong the QT interval)

Advice From The Pharmacist

  • Take pimozide exactly as prescribed. Do not adjust the dose without consulting your healthcare provider.
  • Avoid consuming grapefruit juice while taking pimozide, as it can increase the levels of the drug in your system, leading to potential side effects.
  • Monitor heart health regularly, especially if you have a history of heart problems. Pimozide can prolong the QT interval, increasing the risk of arrhythmias.
  • Report any signs of involuntary movements (such as facial grimacing or lip-smacking) to your healthcare provider, as these may indicate tardive dyskinesia.


Side Effects of Pimozide

Common Side Effects

  • Drowsiness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Weight gain


Uncommon/Severe Side Effects

  • Extrapyramidal symptoms (EPS): Muscle stiffness, tremors, and difficulty moving
  • Tardive dyskinesia: Involuntary movements, especially of the face
  • Cardiac arrhythmias or QT prolongation
  • Neuroleptic malignant syndrome (NMS): A rare but serious reaction causing high fever, muscle rigidity, and confusion


Risks and Warnings of Pimozide

  • QT Prolongation and Arrhythmias: Pimozide can prolong the QT interval, leading to an increased risk of life-threatening heart arrhythmias. Patients should undergo regular ECG monitoring.
  • Tardive Dyskinesia: Prolonged use of pimozide may cause irreversible involuntary movements, particularly in older adults. Discuss the risks with your healthcare provider if long-term use is needed.
  • Neuroleptic Malignant Syndrome: Pimozide can cause this rare but life-threatening condition. Seek immediate medical attention if symptoms such as fever, muscle stiffness, or confusion occur.


Interactions with Pimozide

Common Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): These drugs can increase pimozide levels in the blood, leading to an increased risk of side effects.
  • SSRIs (e.g., fluoxetine, paroxetine): Can increase the risk of QT prolongation.
  • Tricyclic antidepressants (e.g., amitriptyline): May increase the risk of cardiac side effects.
  • St. John’s Wort: May reduce the effectiveness of pimozide by speeding up its breakdown.


Alternatives to Pimozide

  • Risperidone (Risperdal®): An atypical antipsychotic used to treat Tourette’s syndrome and schizophrenia.
  • Aripiprazole (Abilify®): Another atypical antipsychotic, often used for tics in Tourette’s syndrome.
  • Haloperidol (Haldol®): A typical antipsychotic that is also used to treat tics and psychotic disorders.