Pimozide adverse effects

Pimozide, penfluridol and fluspirilene are di-phenylbutylpiperidine derivatives. Pimozide and penfluridol are antipsychotics with high potency but they give relatively few extrapyramidal problems and exhibit minimal other adverse effects. Fluspirilene has similar pharmacological activity although the risk for extrapyramidal reactions seems to be somewhat higher. 

Pimozide is FDA-labeled for Tourette s disorder and is particularly interesting in that it is a highly specific DA antagonist that may produce fewer adverse effects than haloperidol. In open studies with adequate doses, this agent has demonstrated efficacy for acute schizophrenia. Several double-blind trials comparing pimozide with other neuroleptics also found it to be an equally effective maintenance therapy ( 34, 35, 36, 37 and 38). We consider this agent to be as effective as the other standard agents, with the same, but perhaps less severe, side effects. 

Pimozide is an alternative agent for refractory cases or those unable to tolerate haloperidol. In a double-blind, crossover study, pimozide was superior to both haloperidol and placebo (198), in part because of the higher rate of treatment-limiting adverse effects of haloperidol versus pimozide (41% versus 14%). 

T effects OF amiodarone, astemizole, atorvastadn, barbiturates, bepridil, bupropion, cerivastatin, cisapride, clorazepate, clozapine, clarithromycin, desipramine, diazepam, encainide, ergot alkaloids, estazolam, flecainide, flurazepam, indinavir, ketoconazole, lovastatin, meperidine, midazolam, nelfinavir, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, simvastatin, SSRIs, TCAs, terfenadine, triazolam, troleandomycin, zolpidem X effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John s wort, tobacco X effects OF didanosine, hypnotics, methadone, OCPs, sedatives, theophylline, warfarin EMS T Effects of amiodarone, diazepam, midazolam and BBs, may need X- doses concurrent use of Viagra-type drugs can lead to hypotension X- effects of warfarin concurrent EtOH use can T adverse effects T glucose ODs May cause an extension of adverse SEs symptomatic and supportive Rivasrigmine (Exelon) [Cholinesterase Inhibitor/Anri ... 

A recent limited but controlled study indicated that pimozide (Orap) was more effective than carbamazepine. However, the potential for severe extrapyramidal adverse effects with pimozide is considerable, and it is not a drug of choice. 

There was a highly significant reduction in rating scale scores for the syndrome with olanzapine 10 mg versus baseline and versus pimozide 2 mg, and a significant reduction with olanzapine 5 mg versus pimozide 4 mg only moderate sedation was reported by one patient during olanzapine treatment while three complained of minor motor adverse effects and sedation during pimozide treatment. 

Concomitant therapy with astemizole, cisapride, pimozide, or terfenadine Hypersensitivity to erythromycin or any component of the product Adverse effects ... 

PIMOZIDE NNRTIs Possible T efficacy and T adverse effects, e.g. ventricular arrhythmias of pimozide J- CYP3A4-mediated metabolism of pimozide Avoid co-administration... 

ANTIPSYCHOTICS-PIMOZIDE GRAPEFRUIT JUICE Possibly t efficacy and t adverse effects Not evaluated Avoid concomitant use... 

GRAPEFRUIT JUICE ANTIPSYCHOTICS -PIMOZIDE Possibly t efficacy and t adverse effects. Interaction may occur rapidly, but clinical significance is uncertain Not evaluated in clinical trials Avoid concomitant use. No interaction was observed with haloperidol... 

Pimozide levels are expected to rise when used with fluoxetine, fluvoxamine, paroxetine, or sertraline, which would increase the risk of potentially fatal torsade de pointes arrhythmias. The use of SSRIs and pimozide has also led to extrapyramidal adverse effects, oculogyric crises and sedation in rare cases. 

---