Pimozide arrhythmia with

Committee on Safety of Medicines—Medicines Control Agency. Cardiac arrhythmias with pimozide (Orap). Curr Probl Pharmacovigilance 1995 21 1. 

IVABRADINE ANTIPSYCHOTICS Risk of arrhythmias with pimozide and sertindole Additive effect Monitor ECG closely... 

Hypersensitivity to the drug or any other component of the product (cross-sensitivity between phenothiazines may occur) comatose or greatly depressed states caused by CNS depressants or from any other cause (phenothiazines, clozapine, loxapine, molindone, pimozide, haloperidol) coadministration with other drugs that prolong the QT interval and in patients with congenital long QT syndrome or history of cardiac arrhythmias (mesoridazine, thioridazine, pimozide, ziprasidone see Drug..Interactions). 

Ziprasidone, pimozide, mesoridazine, and thioridazine have been shown to prolong the QT interval, and drugs with this potential have been associated with torsade de pointes-type arrhythmias and sudden death. Perform a baseline ECG and measure serum potassium and magnesium before initiation of treatment and periodically during treatment, especially during a period of dose adjustment. Patients with QT interval over 450 msec should not receive mesoridazine or thioridazine. Avoid ziprasidone in patients with histories of significant cardiovascular illness (eg. 

Concomitant administration of clarithromycin with cisapride, pimozide, astemizole, or terfenadine is contraindicated. There have been postmarketing reports of drug interactions when clarithromycin and/ or erythromycin are coadministered with cisapride, pimozide, astemizole, or terfenadine resulting in cardiac arrhythmias (QT prolongation, ventricular tachycardia, ventricular fibrillation, and torsades de pointes). 

ADENOSINE ANTIPSYCHOTICS Risk of ventricular arrhythmias, particularly torsades de pointes, with phenothiazines and pimozide. There is also a theoretical risk of Q-T prolongation with the atypical antipsychotics All of these drugs prolong the Q-T interval Avoid co-administration of phenothiazines, amisulpride, pimozide or sertindole with adenosine. Monitor the ECG closely when adenosine is co-administered with atypical antipsychotics... 

PROPAFENONE I. ANTIARRHYTHMICS - disopyra-mide, procainamide 2. ANTIBIOTICS - macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfopristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS -arsenic trioxide 4. ANTIDEPRESSANTS - TCAs, venlafaxine 5. ANTIEMETICS-dolasetron 6. ANTIFUNGALS-fluconazole, posaconazole, voriconazole 7. ANTIHISTAMINES - terfenadine, hydroxyzine, mizolastine 8. ANTI-M ALARIALS - artemether with lumefantrine, chloroquine, hydroxychloroquine, mefloquine, quinine 9. ANTIPROTOZOALS - pentamidine isetionate 10. ANTIPSYCHOTICS-atypicals, phenothiazines, pimozide II. BETA-BLOCKERS - sotalol 12. BRONCHODILATORS -parenteral bronchodilators 13. CNS STIMULANTS - atomoxetine Risk of ventricular arrhythmias, particularly torsades de pointes Additive effect these drugs prolong the Q-T interval. Also, amitriptyline, clomipramine and desipramine levels may be t by propafenone. Amitriptyline and clomipramine may t propafenone levels. Propafenone and these TCAs inhibit CYP2D6-mediated metabolism of each other Avoid co-administration... 

EKGs may be useful for selected patients (e.g., those with personal or family history of QTc prolongation cardiac arrhythmia recent myocardial Infarction uncompensated heart failure or taking agents that prolong QTc Interval such as pimozide, thioridazine, selected antlarrhythmics, moxifloxacin, spartloxacin, etc.)... 

Use with CYP450 3A4 inhibitors (e.g., drugs such as fluoxetine, sertraline, fluvoxamine, and nefazodone foods such as grapefruit juice) can raise pimozide levels and increase the risks of dangerous arrhythmias... 

Pimozide can increase the QTc interval and potentially cause arrhythmia or sudden death, especially in combination with drugs that raise its levels... 

Pimozide is available as an antipsychotic limited to use as an alternate to haloperidol in the treatment of Tourette s syndrome (TS). It is indicated for patients with severe symptoms who cannot tolerate or do not respond to haloperidol. The adverse reaction profile is similar to that of other neuroleptics however, serious ventricular arrhythmias can occur sudden unexpected deaths have been reported with high doses. 

Because pimozide has anticholinergic properties, it is contraindicated in patients with arrhythmias because the drug may cause ventricular arrhythmias or aggravate existing arrhythmias in patients with congenital Q-T syndrome because it may cause conduction defects and sudden death and in comatose states and CNS depression because of the risk of addictive effects. 

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