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Schizophrenia, Suppression of motor and phonic tics in patients with Tourette syndrome who fail to respond satisfactorily to standard treatment.


Treatment of simple tics or tics other than those associated with Tourette syndrome; drug-induced motor and phonic tics (eg, amphetamine, methylphenidate, pemoline) until it is determined whether the tics are caused by drugs or Tourette syndrome; patients with congenital long QT syndrome, history of cardiac arrhythmias; administration with other drugs that prolong the QT interval or inhibit CYP3A4; patients with hypokalemia or hypomagnesemia; patients receiving aprepitant or the azole antifungal agents itraconazole, ketoconazole, and voriconazole; patients receiving the macrolide antibiotics azithromycin, clarithromycin, dirithromycin, erythromycin, and troleandomycin; patients receiving protease inhibitors (eg, amprenavir, atazanavir, indinavir, nelfinavir, ritonavir, saquinavir); coadministration of nefazodone, sertraline, zileuton, or ziprasidone; severe toxic CNS depression or comatose states from any cause; hypersensitivity to pimozide.

Adverse reactions:

Cardiovascular ECG changes, including prolongation of QT interval, flattening, notching, and inversion of T wave, and appearance of U waves; postural hypotension; hypotension; hypertension; tachycardia; palpitations. CNS Extrapyramidal reactions; motor restlessness; dystonia; akathisia; hyperpyrexia; opisthotonos; tardive dyskinesia; NMS; Parkinsonian syndrome; grand mal seizures; drowsiness; sedation; insomnia; rigidity; speech disorder; handwriting change; akinesia; depression; excitement; nervousness; adverse behavior; headache; abnormal dreaming; hyperkinesia; somnolence; torticollis; limb tremor; dizziness. Dermatologic Rash; increased sweating; skin irritation. EENT Oculogyric crises; visual disturbances; taste change; sensitivity of eyes to light; decreased accommodation; spots before eyes; blurred vision; cataracts. GI Dry mouth; diarrhea; constipation; thirst; increased appetite; dysphagia; increased salivation; nausea; vomiting; anorexia; GI distress. Genitourinary Menstrual disorder; breast secretions; impotence; nocturia; urinary frequency; loss of libido. Miscellaneous Sudden, unexpected death; hyperpyrexia; muscle cramps and tightness; stooped posture; asthenia; myalgia; chest pain; periorbital edema.


CNS depressants (eg, analgesics, anxiolytics, sedatives) Pimozide may potentiate effects of these agents. Drugs that may cause motor or phonic tics (eg, amphetamine, methylphenidate, pemoline) Coadministration with pimozide is contraindicated. Drugs that prolong the QT interval (eg, aprepitant, arsenic trioxide, class Ia or III antiarrhythmic agents [eg, dofetilide, quinidine, sotalol], dolasetron mesylate, droperidol, levomethadyl acetate, macrolide antibiotics [eg, azithromycin, clarithromycin, dirithromycin, erythromycin], mefloquine, nefazodone, pentamidine, certain phenothiazines [eg, chlorpromazine, mesoridazine, thioridazine], probucol, certain quinolone antibiotics [gatifloxacin, moxifloxacin, sparfloxacin], sertraline, tricyclic antidepressants [eg, amitriptyline], tacrolimus, telithromycin, voriconazole, zileuton, ziprasidone) Coadministration of these agents with pimozide is contraindicated. Drugs that inhibit CYP3A4 (eg, azole antifungal agents [eg, itraconazole, ketoconazole], protease inhibitors [amprenavir, indinavir, nelfinavir, ritonavir, saquinavir]) Coadministration of these agents with pimozide is contraindicated. Grapefruit juice May increase pimozide concentration, increasing the pharmacologic and adverse reactions. Avoid grapefruit juice and grapefruit products.


Pregnancy Category C . Lactation Undetermined. Children Limited information regarding use, efficacy, and safety in patients younger than 12 yr of age. Renal Function Use with caution. Hepatic Function Use with caution. Special Risk Patients Use with caution in patients with conditions that may be aggravated by anticholinergic activity, patients receiving anticonvulsant medication, patients with history of seizures or EEG abnormalities. NMS This potentially fatal condition has been reported in association with antipsychotic agents. Signs and symptoms include hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or BP, tachycardia, diaphoresis, cardiac arrhythmias. Sudden death Sudden, unexpected deaths have occurred in patients receiving dosages in the range of 1 mg/kg. Prolongation of the QT interval, predisposing patients to ventricular arrhythmia, is one possible mechanism for the deaths. Ensure ECG is performed before initiating therapy and periodically thereafter, especially during periods of dose adjustment. Ensure hypokalemia and hypomagnesemia are corrected before initiating therapy and normal potassium and magnesium levels are maintained during therapy. Withhold therapy if QTc interval prolongs beyond 0.47 sec (children), 0.52 sec (adults), or more than 25% above baseline QTc. Tardive dyskinesia This syndrome of potentially irreversible, involuntary dyskinetic movements has occurred with other antipsychotic agents. Incidence appears to be highest among the elderly, especially women.



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