Pimozide (oral)

What is the most important information I should know about pimozide?

Do not take pimozide with any of the following medicines:

• antibiotics including azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (Ery-Tab, E.E.S., E-Mycin, Eryc, PCE, and others), dirithromycin (Dynabac), and troleandomycin (TAO);
• antifungal medicines including itraconazole (Sporanox) and ketoconazole (Nizoral);
• protease inhibitors including amprenavir (Agenerase), ritonavir (Norvir), saquinavir (Fortovase, Invirase), indinavir (Crixivan), and nelfinavir (Viracept);
• phenothiazines including chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), mesoridazine (Serentil), and trifluoperazine (Stelazine);
• tricyclic antidepressants including amoxapine (Asendin), amitriptyline (Elavil, Endep), clomipramine (Anafranil), doxepin (Sinequan), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil);
• medicines for irregular heartbeats, including quinidine (Cardioquin, Quinora, Quinaglute, Quinidex), procainamide (Pronestyl, Procan SR), disopyramide (Norpace), propafenone (Rythmol), flecainide (Tambocor), amiodarone (Cordarone), and sotalol (Betapace);
• nefazodone (Serzone);
• zileuton (Zyflo); or
• sertraline (Zoloft).

A dangerous interaction, possibly resulting in irregular heartbeats and/or death may occur if pimozide is taken with any of the medicines listed above.

Do not consume grapefruit or grapefruit juice during treatment with pimozide. Pimozide can interact with grapefruit products, and the interaction may have dangerous effects.

Call your doctor immediately if you experience uncontrollable movements of the mouth, tongue, cheeks, jaw, arms, or legs; fever; muscle rigidity; sweating; irregular pulse; or fast or irregular heartbeats.

Use caution when driving, operating machinery, or performing other hazardous activities. Pimozide may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.

Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking pimozide.

Avoid becoming overheated in hot weather and during exercise. Pimozide increases the risk of heat stroke. Drink plenty of fluids to maintain hydration.

What is pimozide?

Pimozide is an antipsychotic medication. It works by changing the actions of chemicals in the brain.

Pimozide is used to suppress the motor and phonic tics associated with Tourette's disorder.

Pimozide may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking pimozide?

Do not take pimozide with any of the following medicines:

• antibiotics including azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (Ery-Tab, E.E.S., E-Mycin, Eryc, PCE, and others), dirithromycin (Dynabac), and troleandomycin (TAO);
• antifungal medicines including itraconazole (Sporanox) and ketoconazole (Nizoral);
• protease inhibitors including amprenavir (Agenerase), ritonavir (Norvir), saquinavir (Fortovase, Invirase), indinavir (Crixivan), and nelfinavir (Viracept);
• phenothiazines including chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), mesoridazine (Serentil), and trifluoperazine (Stelazine);
• tricyclic antidepressants including amoxapine (Asendin), amitriptyline (Elavil, Endep), clomipramine (Anafranil), doxepin (Sinequan), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil);
• medicines for irregular heartbeats, including quinidine (Cardioquin, Quinora, Quinaglute, Quinidex), procainamide (Pronestyl, Procan SR), disopyramide (Norpace), propafenone (Rythmol), flecainide (Tambocor), amiodarone (Cordarone), and sotalol (Betapace);
• nefazodone (Serzone);
• zileuton (Zyflo); or
• sertraline (Zoloft).

A dangerous interaction, possibly resulting in irregular heartbeats and/or death may occur if pimozide is taken with any of the medicines listed above.

Do not take pimozide without first talking to your doctor if you have

• liver disease;
• kidney disease;
• heart disease or other heart problems such as high blood pressure, a history of a heart attack, or irregular heartbeats;
• seizures or epilepsy;
• an enlarged prostate or difficulty urinating; or
• glaucoma.

You may not be able to take pimozide, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Pimozide is in the FDA pregnancy category C. This means that it is not known whether pimozide will be harmful to an unborn baby. Do not take pimozide without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether pimozide passes into breast milk. Do not take pimozide without first talking to your doctor if you are breast-feeding a baby.

How should I take pimozide?

Take pimozide exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

Never take more of this medication than is prescribed for you.

Do not consume grapefruit or grapefruit juice during treatment with pimozide. Pimozide can interact with grapefruit products, and the interaction may have dangerous effects.

Talk to your doctor before you stop taking this medication. It may be several weeks before you begin to feel better, and you may require continuous treatment for quite some time. A gradual reduction in dose may be recommended before stopping the medication.

Store pimozide at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a pimozide overdose include dizziness, drowsiness, uncontrollable movements, coma, and death.

What should I avoid while taking pimozide?

Use caution when driving, operating machinery, or performing other hazardous activities. Pimozide may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.

Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking pimozide.

Avoid becoming overheated in hot weather and during exercise. Pimozide increases the risk of heat stroke. Drink plenty of fluids to maintain hydration.

Do not consume grapefruit or grapefruit juice during treatment with pimozide. Pimozide can interact with grapefruit products, and the interaction may have dangerous effects.

What are the possible side effects of pimozide?

Call your doctor immediately if you experience uncontrollable movements of the mouth, tongue, cheeks, jaw, arms, or legs; fever; muscle rigidity; sweating; irregular pulse; or fast or irregular heartbeats.

If you experience any of the following serious side effects, stop taking pimozide and seek emergency medical attention or notify your doctor immediately:

• an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
• seizures or convulsions;
• fever; or
• a very fast or an irregular heartbeat.

Other, less serious side effects may be more likely to occur. Continue to take pimozide and talk to your doctor if you experience

• dizziness or drowsiness;
• insomnia;
• nausea or vomiting;
• diarrhea or constipation;
• dry mouth; or
• blurred vision or sensitivity of the eyes to light.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect pimozide?

Do not take pimozide with any of the following medicines:

• antibiotics including azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (Ery-Tab, E.E.S., E-Mycin, Eryc, PCE, and others), dirithromycin (Dynabac), and troleandomycin (TAO);
• antifungal medicines including itraconazole (Sporanox) and ketoconazole (Nizoral);
• protease inhibitors including amprenavir (Agenerase), ritonavir (Norvir), saquinavir (Fortovase, Invirase), indinavir (Crixivan), and nelfinavir (Viracept);
• phenothiazines including chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), mesoridazine (Serentil), and trifluoperazine (Stelazine);
• tricyclic antidepressants including amoxapine (Asendin), amitriptyline (Elavil, Endep), clomipramine (Anafranil), doxepin (Sinequan), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil);
• medicines for irregular heartbeats, including quinidine (Cardioquin, Quinora, Quinaglute, Quinidex), procainamide (Pronestyl, Procan SR), disopyramide (Norpace), propafenone (Rythmol), flecainide (Tambocor), amiodarone (Cordarone), and sotalol (Betapace);
• nefazodone (Serzone);
• zileuton (Zyflo); or
• sertraline (Zoloft).

A dangerous interaction, possibly resulting in irregular heartbeats and/or death may occur if pimozide is taken with any of the medicines listed above.

Pimozide should not be taken with other medicines that, may themselves, cause motor and phonic tics including

• pemoline (Cylert);
• methylphenidate (Ritalin, Concerta, Metadate, Methylin);
• dexmethylphenidate (Focalin); and
• amphetamines such as amphetamine, amphetamine-dextroamphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat), and methamphetamine (Desoxyn).

Talk to your doctor before taking pimozide if you are taking any of the medicines listed above.

Tell your doctor if you are taking any medicines to treat a seizure disorder. Pimozide may increase the risk of having a seizure.

Pimozide may also increase the side effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (medicines that treat insomnia), pain relievers, anxiety medicines, muscle relaxants, and any other drug that makes you feel sleepy or relaxed. Tell your doctor about all medicines that you are taking and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with pimozide. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

Where can I get more information?

Your pharmacist has more information about pimozide written for health professionals that you may read.

What does my medication look like?

Pimozide is available with a prescription under the brand name Orap. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Orap 1 mg--white, oval, scored tablets
• Orap 2 mg--white, oval, scored tablets

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2003 Cerner Multum, Inc. Version: 4.04. Revision date: 9/8/04.