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Antipsychotic

Pimozide

Pimozide is an antipsychotic medication primarily used to treat Tourette’s syndrome, targeting involuntary movements and vocalizations by blocking dopamine receptors in the brain. Approved by the FDA, it is prescribed when other ineffective treatments are available in 1mg and 2mg tablets. Dosages are carefully adjusted based on individual needs, with a maximum daily limit of 10 mg. While effective, pimozide can cause side effects like drowsiness, dry mouth, and more severe conditions such as Neuroleptic Malignant Syndrome and heart rhythm changes. Patients must stick to their prescribed regimen and monitor their health closely. Pimozide requires safe storage and regular medical oversight to ensure its efficacy and safety.

Pimozide Overview

Pimozide is a potent antipsychotic medication containing the active ingredient pimozide, primarily used for managing Tourette’s syndrome. This condition is characterized by involuntary, repetitive movements and vocalizations known as tics. Pimozide works by blocking dopamine receptors in the brain, particularly D2 receptors, which helps reduce these symptoms. Approved by the FDA, it is used when alternative treatments have failed to deliver sufficient relief. The drug may also be used off-label for certain severe cases of treatment-resistant obsessive-compulsive disorder (OCD), demonstrating its versatility and effectiveness in treating complex neurological disorders.

Pimozide is available in tablet form in strengths of 1mg and 2mg. The recommended starting dose for adults with Tourette’s syndrome is typically 1 to 2 mg daily, divided into two doses, with gradual increases to manage symptoms effectively without exceeding a maximum of 10 mg per day. Children aged 12 and over start with a dose calculated based on body weight, ensuring a tailored approach to treatment. Pimozide should be taken with water, and it can be consumed with or without food. Given its potent effects, users must adhere closely to prescribed dosages and schedules to maximize benefits and minimize risks.

Despite its benefits, pimozide can cause side effects such as drowsiness, dry mouth, constipation, and dizziness. More severe risks include Neuroleptic Malignant Syndrome, Tardive Dyskinesia, and changes in heart rhythm, necessitating careful monitoring and immediate medical attention if symptoms appear. Patients should not miss doses and avoid doubling up on doses in case of a missed one. Store pimozide at room temperature, away from moisture and light, and keep it out of reach of children. A boxed warning from the FDA regarding cardiac arrhythmias accompanies this medication. It necessitates regular ECG monitoring, highlighting the importance of following medical guidance and adhering to prescribed protocols for use.

Uses of Pimozide

  • Treatment for Tourette syndrome when other standard medications have been ineffective.

Pimozide Dosage

Strengths and Forms

Tablets

  • 1mg
  • 2mg

Recommended Dosage of Pimozide for Different Patients

Adults with Tourette’s Syndrome:

  • Initial dose: 1 to 2 mg daily, divided into two doses.
  • Titration: Increase the dose gradually by 1 mg every other day.
  • Maximum dose: Do not exceed 10 mg daily.

Children with Tourette’s Syndrome (12 years and older):

  • Initial dose: 0.05 mg per kg body weight per day, divided into two doses.
  • Titration: Increase the dose gradually by 0.05 mg per kg every other day.
  • Maximum dose: Do not exceed 10 mg daily.

Geriatric Patients:

  • Initial dose: Start at the lower end of the dosing range.
  • Titration: Adjust the dose gradually based on the patient’s response and tolerability.
  • Monitoring: Close monitoring for side effects and efficacy is recommended.

Patients with Liver or Kidney Impairment:

  • Dose adjustment: Lower doses may be necessary.
  • Monitoring: Regular monitoring of liver and kidney function is advised.

General Recommendations:

  • Titration: Increase the dose slowly to minimize the risk of side effects.
  • Monitoring: Regular ECG monitoring is recommended due to the risk of heart rhythm changes.
  • Administration: Take pimozide simultaneously each day, with or without food.

 

[Note: Keep in mind that recommendations for Pimozide can differ based on individual factors. Consult with your healthcare provider, who will tailor your dosage to suit your specific needs.]

How to Take Pimozide?

  • Swallow the Pimozide tablet whole with a glass of water. Do not crush, chew, or break the Pimozide tablet.
  • Do not stop taking pimozide suddenly without consulting your medical expert, as this may worsen your condition.
  • Attend regular check-ups with your doctor to record your progress and adjust the dosage if needed.
  • Store pimozide at an average temperature, away from moisture, heat, and light. Keep the medication out of reach of children and pets.
  • Practice caution when driving or performing tasks that demand mental alertness, as pimozide can cause drowsiness and dizziness.
  • Avoid drinking alcohol and consuming grapefruit or grapefruit juice while taking pimozide, as these can increase the risk of side effects.

[Note: Your medical expert will decide the right amount of Pimozide for you based on your health condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Pimozide Work?

Pimozide is an antipsychotic medication primarily used to treat symptoms of Tourette’s syndrome, such as uncontrollable tics and vocalizations. It belongs to a class of drugs known as typical antipsychotics. Pimozide works by blocking dopamine receptors in the brain, particularly D2 receptors. Dopamine is a neurotransmitter involved in mood, behavior, and movement. By inhibiting dopamine’s action, pimozide helps reduce the severity & frequency of tics and other symptoms related to Tourette’s syndrome. Additionally, it may be used off-label for treating certain types of severe, treatment-resistant obsessive-compulsive disorder (OCD) and other psychiatric conditions.

Important Safety Information

Pimozide Side Effects

Common side effects of Pimozide may include:

  • Drowsiness or sedation
  • Dry mouth
  • Constipation
  • Blurred vision
  • Weight gain
  • Dizziness
  • Tremors or muscle stiffness
  • Restlessness
  • Changes in heart rhythm (QT prolongation)
  • Increased prolactin levels

 

Serious side effects of Pimozide may include:

  • Neuroleptic Malignant Syndrome (NMS): A potentially fatal condition characterized by high fever, muscle rigidity, altered mental status, and autonomic instability.
  • Tardive Dyskinesia: Involuntary, repetitive body movements, often affecting the face and tongue. This can be irreversible.
  • QT Prolongation: An abnormal heart rhythm resulting in dangerous arrhythmias, including Torsades de Pointes.
  • Severe Extrapyramidal Symptoms: Extreme muscle stiffness, tremors, or spasms.
  • Agranulocytosis: A severe drop in white blood cell count, increasing the risk of infections.
  • Seizures: This is especially important for patients with a history of seizures or epilepsy.
  • Severe allergic reactions: Including anaphylaxis, angioedema, or severe skin reactions.
  • Priapism: Prolonged and painful erection.
  • Liver dysfunction: Indicated by jaundice, dark urine, or abdominal pain.
  • Significant weight gain and metabolic changes: Can increase the risk of diabetes and cardiovascular issues.
  • Hyperprolactinemia: Elevated prolactin levels can cause breast enlargement, milk production, and sexual dysfunction.
  • Severe mood changes, Including increased depression or suicidal thoughts.

 

[Note: Remember, this list does not cover all possible side effects of Pimozide. Always consult with your healthcare expert for medical advice about side effects.]

Pimozide Warnings

  • Movement problems: Drugs used to treat psychosis, including pimozide, can induce a movement disorder referred to as tardive dyskinesia (TD). TD can make it difficult to control your movements, with common symptoms including lip smacking, eye blinking, tongue protrusion, and grimacing. The risk of developing TD and the possibility of it becoming permanent is higher with long-term use or high doses of antipsychotics. Inform your provider if you notice any of these signs. Sometimes, these movements may subside once you stop the medication.
  • Neuroleptic malignant syndrome: A rarely seen but life-threatening condition associated with antipsychotic medications. Symptoms include high fever, rapid heart rate, full-body stiffness, and confusion. Seek immediate medical attention if you experience these symptoms. Your healthcare specialist will likely switch you to a different medication that may be safer for you.
  • Higher risk of infection: Taking pimozide can decrease your white blood cell count, which is crucial for infection resistance. Your provider will monitor your blood cell levels with routine blood tests and may stop the medication if your levels are too low. Inform your healthcare expert if you have persistent symptoms of an infection, such as fever or sore throat.
  • Heart rhythm changes: Clinical studies have shown that pimozide can cause changes in heart rhythm, as seen on ECG scans. Because of this risk, you will need to have an ECG scan before starting pimozide and regularly while taking the medication to ensure your heart rhythm remains normal. Pimozide should not be used if you have a condition or are taking other medicines that can affect heart rhythm.

Pimozide Boxed Warning 

Pimozide has a boxed warning, the most severe type of warning required by the U.S. Food and Drug Administration (FDA). The boxed warning for Pimozide includes the following key points:

  • QT Prolongation and Cardiac Arrhythmias: Pimozide can prolong the QT interval in the heart’s electrical cycle. This effect can potentially lead to serious and life-threatening cardiac arrhythmias, including Torsades de Pointes and sudden death. The risk increases with higher doses and in patients with certain conditions.
  • ECG Monitoring: An electrocardiogram (ECG) should be performed before initiating treatment with Pimozide and periodically after that, significantly when increasing the dose. 

Pimozide Precautions

  • Tell your doctor and pharmacist if you have any allergies to pimozide, medications used for mental health conditions, or any other drugs.
  • Notify your doctor if you are taking antibiotics like azithromycin, clarithromycin, erythromycin, or moxifloxacin; antifungals like itraconazole and ketoconazole; or other medications like arsenic trioxide, dofetilide, chlorpromazine, dolasetron, droperidol, HIV protease inhibitors (indinavir, nelfinavir, saquinavir, ritonavir), medicines for irregular heartbeat (amiodarone, disopyramide, procainamide, quinidine, sotalol), mental illness, nausea, mefloquine, nefazodone, pentamidine, certain SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), tacrolimus, thioridazine, zileuton, or ziprasidone. Your doctor may advise against taking pimozide.
  • Tell your medical expert if you are taking medications that may cause tics, such as amphetamines (Adderall, Dexadrine), pemoline (not available in the US), and methylphenidate (Concerta, Ritalin). Your doctor may ask you to discontinue these medications before starting pimozide to determine if they caused the tics.
  • Inform your qualified medical professional about all prescription and nonprescription medications, vitamins, supplements, and herbal products you are currently taking or plan to take. Mention antidepressants, cimetidine, diuretics, drugs for anxiety, pain, and seizures, sedatives, sleeping pills, ticlopidine, and tranquilizers.
  • Tell your doctor if you have had long QT syndrome, an irregular heartbeat, or low potassium or magnesium levels. Also, mention if you have severe diarrhea before or during treatment. Your doctor may advise against taking pimozide.
  • Disclose any history of breast cancer, Parkinson’s disease, glaucoma, urination problems, balance issues, abnormal EEG, seizures, or prostate, liver, or kidney disease. Inform your doctor if you have ever had to stop a mental illness medication due to severe side effects.
  • If you are pregnant, especially in the last few months, plan to become pregnant, or are breastfeeding, inform your doctor. If you become pregnant while taking pimozide, connect with your doctor immediately, as it may cause problems in newborns.
  • Inform your doctor or dentist if you are having surgery, including dental surgery, that you are taking pimozide.
  • Be aware that pimozide may cause drowsiness and affect thinking and movements, especially at the beginning of treatment. Do not drive or handle machinery until you’re sure of the medication’s effects on you.
  • Pimozide may cause you to feel dizzy, lightheaded, or faint if you get up suddenly from a lying position. To prevent this, rise slowly and rest your feet on the floor before standing.
  • Ask your medical professional about the safe use of alcohol while taking pimozide, as it can worsen side effects.

Pimozide Contraindications 

Contraindications are particular health conditions or circumstances in which taking a medication is unsafe for a person. If you have any of the following conditions or if any of the following apply to you, inform your healthcare provider, as pimozide will not be safe for you to take:

  • Treatment of tics not associated with Tourette’s syndrome.
  • Tics are caused by medications such as pemoline, methylphenidate (Ritalin), and amphetamines.
  • Irregular heartbeat problems
  • Severe toxic central nervous system depression or coma from any cause.
  • Concurrent use of citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), macrolide antibiotics (e.g., azithromycin (Zithromax), clarithromycin, erythromycin (Ery-Tab)), or other medications that significantly slow down the breakdown of pimozide in the body.

Pimozide Missed Dose

If you miss a dose of Pimozide, here’s what you should do:

  • Take it as soon as you remember unless it’s almost time for your next scheduled dose.
  • If your next dose is almost due, skip the missed dosage of Pimozide and continue with your regular dosing schedule.
  • Do not double-up doses to make up for the missed one. Doing so can increase the risk of side effects.
  • If you miss doses frequently, consider setting reminders or using a pill organizer to help you keep track of your medication.
  • Maintaining consistent blood levels for medication is crucial, so try to take it simultaneously daily.
  • If you’ve missed several doses, consult your doctor before restarting, as they may need to adjust your dosage.
  • Keep track of missed doses and report this to your doctor at your next appointment.

[Note: If you miss a medication dose and are uncertain when to take the next one, consult your doctor or pharmacist immediately.]

Pimozide Overdose 

An overdose of Pimozide is a severe medical emergency that requires immediate attention. The symptoms of a Pimozide overdose can be severe and potentially life-threatening.

Common signs of a Pimozide overdose may include extreme drowsiness, confusion, slurred speech, muscle stiffness or spasms, tremors, slow or irregular heartbeat, fainting, and seizures. In the most severe cases, there could be a loss of consciousness, entering into a coma, or death.

[Note: If you have taken more than the recommended dose, seek medical assistance immediately or call the Poison Help line at 1-800-222-1222.]

Pimozide Storage

  • Store at room temperature, typically between 68°F to 77°F.
  • Keep in a dry place. Avoid storing in bathrooms.
  • Protect from light. Store in the original container or a light-resistant container.
  • Keep the container tightly closed when not in use.
  • Store in the original packaging or container.
  • Keep out of reach of children and pets.
  • Not required unless specifically instructed by your pharmacist or doctor.
  • Do not use Pimozide medication after the expiration date printed on the package.
  • When traveling, carry medications in your carry-on luggage to avoid extreme temperatures in checked baggage.
  • Properly dispose of expired or unused medication as directed by your pharmacist or local guidelines.

[Note: Consult your healthcare professional about correctly disposing of unused medication and address any questions regarding its storage.]

Pimozide Interactions

  • Antifungal medications: (e.g., ketoconazole, itraconazole) can increase pimozide levels in the blood, increasing the risk of side effects.
  • Antibiotics: (e.g., erythromycin, clarithromycin) can also elevate pimozide levels.
  • Antidepressants: Certain SSRIs (e.g., fluoxetine, sertraline) can increase the risk of heart rhythm problems.
  • Antiviral drugs: (e.g., ritonavir) used to treat HIV can increase pimozide levels.
  • Antiarrhythmics: (e.g., amiodarone, quinidine) can increase the risk of severe heart rhythm issues.
  • Calcium channel blockers: (e.g., verapamil, diltiazem) can increase pimozide levels.
  • Other antipsychotics: Using other antipsychotic medications with pimozide can increase the risk of side effects.
  • Grapefruit juice: It can elevate the levels of pimozide in the bloodstream, increasing the likelihood of adverse effects.

[Note: There may be additional drugs that interact with Pimozide, as this list is not comprehensive. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Pimozide Alternatives

[Note: Your healthcare provider will choose the most appropriate medication. Avoid using any alternative treatments without consulting your doctor, as doing so could result in serious adverse effects.] 

Frequently Asked Questions

Can pimozide cause tardive dyskinesia?

Yes, all antipsychotic medications, including pimozide, can cause tardive dyskinesia (TD). TD is a side effect involving uncontrollable, repetitive facial movements. If you notice these symptoms, inform your healthcare provider immediately.

How long does it take for pimozide to work?

The impact of pimozide usually becomes apparent within a few weeks. Most studies evaluate the medication’s impact after at least one month of use.

Can pimozide cause weight gain?

Gaining weight is not a typical adverse effect of taking pimozide. However, in clinical trials, some individuals experienced weight changes. While some people gained weight, others lost weight.

Can pimozide be used during pregnancy?

Using pimozide and other antipsychotic medications during the third trimester of pregnancy can be harmful to your baby. Babies might be born with movement disorders or withdrawal symptoms. If you’re pregnant or planning to become pregnant, discuss your treatment options with your healthcare specialist.

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