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First-generation antipsychotic (diphenylbutylpiperidine)

Pimozide

Brand names: Orap

Adult dose

Dose: Schizophrenia: 2–20mg OD. Tourette's: 1–10mg OD. Specialist initiation

Route: PO

Frequency: OD

Clinical pearls

Tourette's syndrome, refractory schizophrenia — specialist
ECG before and during therapy mandatory

Contraindications

QT prolongation
Concurrent CYP3A4/2D6 inhibitors
Concurrent QT-prolonging drugs
Hypokalaemia

Side effects

QT prolongation
Sudden cardiac death
EPS
Sedation
Hyperprolactinaemia
Anticholinergic effects

Interactions

CYP3A4/2D6 inhibitors (clarithromycin, fluoxetine, paroxetine)
QT-prolonging drugs

Monitoring

ECG
Electrolytes
Weight
Glucose
Prolactin

Reference: BNF; SmPC; https://bnf.nice.org.uk/drugs/pimozide/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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