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Overview: Pimozide is used to manage tics caused by Tourette syndrome. It belongs to a group of medicines called first-generation (typical) antipsychotics. Common side effects include blurred vision, constipation, drowsiness, and dry mouth. Serious side effects may include uncontrolled movements, blood disorders, and heart rhythm changes.

Uses

What is pimozide used for?

Pimozide is commonly used to manage sudden movements and sounds, also called tics, that are caused by Tourette syndrome.

Pimozide may also be used for other conditions as determined by your healthcare provider.

How does pimozide work (mechanism of action)?

Pimozide belongs to a group of medicines called first-generation (typical) antipsychotics. It blocks some areas in the brain where the natural chemical, dopamine, works. This lowers the effect of dopamine in the body. Dopamine affects your behavior and thinking.

How is pimozide supplied (dosage forms)?

Brands and other names

  • Orap

Dosage forms and strengths

  • 1 mg oral tablets
  • 2 mg oral tablets

How should I store pimozide?

Pimozide should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place, in a tight, light-resistant container.

Side Effects

What are the most common side effects of pimozide?

The most common side effects of pimozide are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Blurred vision
  • Constipation
  • Drowsiness
  • Dry mouth
  • Headache
  • Restlessness
  • Weakness

There may be other side effects of pimozide that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of pimozide?

While less common, the most serious side effects of pimozide are described below, along with what to do if they happen.

Severe Allergic Reactions. Pimozide may cause allergic reactions, which can be serious. Stop taking pimozide and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Parkinson-like Symptoms. Pimozide may cause involuntary movement problems, including shakiness, stiffness, or jerkiness. It can also cause drooling, falling, or walking or balance problems. These are called Parkinson-like symptoms, or parkinsonism. Call your healthcare provider right away if you develop any Parkinson-like symptoms.

Uncontrolled Movements. Pimozide can cause some people to have movements that they cannot control. This condition, called tardive dyskinesia (TD), can cause jerky movements of your face, tongue, or body. TD can be permanent. Call your healthcare provider right away if you have any symptoms of TD.

  • Tongue sticking out
  • Lip smacking or puckering
  • Grimacing
  • Rapid eye blinking
  • Jerking or twisting motion of the arms, legs, or trunk

Neuroleptic Malignant Syndrome (NMS). Antipsychotic medicines, like pimozide, can cause a rare but serious condition called neuroleptic malignant syndrome. NMS can lead to death. Stop taking pimozide and call your healthcare provider right away if you have any of the following symptoms.

  • High fever
  • Muscle stiffness or rigidity, where it is hard to move
  • Changes in your breathing or heart rate
  • Increased sweating
  • Confusion

Blood Disorders. Pimozide can cause blood disorders, such as agranulocytosis, low neutrophil levels (neutropenia), and low white blood cell levels (leukopenia). Keep all appointments to have your blood checked. Call your healthcare provider right away if you have any of the following symptoms of blood disorders.

  • Fever, chills, or sweats
  • Sore throat, cough, or shortness of breath
  • Frequent infection
  • Unusual weakness or tiredness
  • Sores in your mouth or throat
  • Swollen lymph nodes

Heart Rhythm Changes. Pimozide may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take medicines that can prolong the QT interval. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

High Prolactin Level (Hyperprolactinemia). Pimozide may cause an increased level of the hormone prolactin in your blood. Increased levels of prolactin could lead to fertility or bone problems. Contact your healthcare provider if you have any of the following symptoms.

  • Vaginal dryness
  • Irregular or no periods
  • Production of breastmilk when not pregnant or nursing
  • Inability to get or keep an erection
  • Enlarged breast size (gynecomastia)
  • Decreased muscle and body hair

Warnings & Precautions

Who should not use pimozide?

Allergies to Ingredients. People who are allergic to any of the following should not take pimozide.

  • Pimozide
  • Any other medicine known as an antipsychotic
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific pimozide products they stock.

Drug Interactions. Pimozide should not be taken while you are taking certain other medicines. Before taking pimozide, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are taking. See the Interactions section for more details.

Other Types of Tics. Pimozide should not be used to treat tics that are not caused by Tourette syndrome. Talk with your healthcare provider if you are not sure what causes your tics. 

Heart Rhythm Problems. Pimozide should not be taken if you have certain abnormal heart rhythms, such as the electrocardiogram (ECG) abnormality called QT prolongation.

Decreased Awareness. Pimozide should not be used by people who are in a coma or who have decreased consciousness.

What should I know about pimozide before using it?

Do not take pimozide unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share pimozide with other people, even if they have the same condition as you. It may harm them.

Keep pimozide out of the reach of children.

People 65 and older can be at greater risk for some side effects from pimozide. Talk to your healthcare provider about your risks if you are in this age group.

Pimozide can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how pimozide affects you.

Do not stop taking pimozide without talking to your healthcare provider. Stopping too quickly may cause serious side effects. Call your healthcare provider right away if you have uncontrolled movements of the face, arms, or legs when stopping pimozide.

What should I tell my healthcare provider before using pimozide?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if pimozide is right for you.

In particular, make sure that you discuss any of the following.

Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Breast cancer
  • Glaucoma
  • Inability to empty your bladder
  • Low blood cell levels
  • Low magnesium or potassium levels
  • Liver or kidney problems
  • Slow heartbeat
  • Seizures or convulsions
  • History of neuroleptic malignant syndrome (NMS)
  • History of alcohol misuse

Pregnancy. It is not known if or how pimozide could affect pregnancy or harm an unborn baby. Taking pimozide during the third trimester of pregnancy could cause a newborn baby to have symptoms such as agitation, breathing problems, or trouble feeding. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take pimozide while you are pregnant or trying to get pregnant.

Breastfeeding. It is not known if pimozide passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop pimozide.

Interactions

Does pimozide interact with foods or drinks?

Avoid drinking grapefruit juice while taking pimozide. Grapefruit juice can increase levels of pimozide in your body and may increase the risk of side effects.

It is unknown if drinking alcohol will affect pimozide. The risk of sleepiness and reduced alertness or concentration may be increased if you drink alcohol while taking pimozide.

Does pimozide interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking pimozide.

  • A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
  • An antipsychotic medicine, such as chlorpromazine, thioridazine, or ziprasidone, which is a medicine for certain mental health conditions
  • A medicine used to control your heart rate or rhythm (antiarrhythmic), such as dofetilide, quinidine, or sotalol
  • A medicine used to treat nausea and vomiting, such as droperidol
  • A macrolide antibiotic, such as azithromycin, clarithromycin, or erythromycin, which is a medicine used for bacterial infections
  • A fluoroquinolone antibiotic, such as moxifloxacin, which is a medicine used for bacterial infections
  • An azole antifungal, such as fluconazole or itraconazole, which is a medicine used for fungal infections
  • Tacrolimus, which is a medicine used to help prevent rejection of a transplanted organ
  • A protease inhibitor, such as indinavir, nelfinavir, or ritonavir, which is a medicine commonly used to treat HIV
  • Mefloquine, which is a medicine for malaria
  • Pentamidine, which is used to prevent certain infections in people living with HIV
  • A selective serotonin reuptake inhibitor (SSRI) or a serotonin and norepinephrine reuptake inhibitor (SNRI), which is a medicine commonly used for anxiety and depression
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems

Many other medicines may alter the blood levels of pimozide. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with pimozide. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much pimozide?

If you or someone else has used too much pimozide, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of pimozide?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.