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First-generation antipsychotic (diphenylbutylpiperidine)

Pimozide

Brand names: Orap

Pimozide is a diphenylbutylpiperidine first-generation antipsychotic used in schizophrenia and persistent monosymptomatic delusional or hypochondriacal states.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a potent central dopamine D2 receptor antagonist, which mediates its antipsychotic effect.

Prescribing in practice

  • Pimozide carries a significant risk of QT-interval prolongation and serious ventricular arrhythmias, so a baseline ECG is required and it is contraindicated with other QT-prolonging or interacting drugs.
  • It is metabolised by CYP3A4 and CYP2D6, making it subject to important interactions with enzyme inhibitors that raise plasma levels.
  • Extrapyramidal effects and neuroleptic malignant syndrome can occur, as with other first-generation antipsychotics.

Monitoring

Perform a baseline and periodic ECG to monitor the QT interval, alongside review for extrapyramidal symptoms and serum electrolytes.

Counselling the patient

  • You will need heart tracings (ECGs) before and during treatment to check your heart rhythm.
  • Tell your doctor or pharmacist before taking any new medicine, including ones bought without a prescription.
  • Report any fainting, palpitations, muscle stiffness or high fever promptly.

Evidence & guidelines

The requirement for ECG monitoring with pimozide reflects MHRA advice and SPC warnings on QT prolongation.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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