Pimozide belongs to the class of medications called antipsychotics. It is used for the management of the symptoms of certain types of chronic schizophrenia. It works by affecting the way messages are sent in the central nervous system (CNS).

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

The recommended starting dose of pimozide ranges from 2 mg to 4 mg once daily, taken in the morning. Your doctor will gradually increase your dose up to a maximum of 20 mg daily. The goal is to find the dose where the best effects occur with the least amount of side effects.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is very important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not double doses.

Orap^® is available in strengths of 2 mg and 4 mg.

2 mg: Each white, round, flat face bevelled-edged tablet, scored and embossed "PIM 2" on the same side, contains pimozide 2 mg. Nonmedicinal ingredients: calcium stearate, cornstarch, lactose, and microcrystalline cellulose.

4 mg: Each green, round, flat-faced, bevelled-edged tablet, scored and embossed "PIM 4" on the same side, contains pimozide 4 mg. Nonmedicinal ingredients: calcium stearate, FD&C Blue No. 1, FD&C Yellow No. 5 (tartrazine), lactose, microcrystalline cellulose, and starch (corn). Sodium: <1 mmol (<1 mg).

This medication does not contain gluten or sodium metabisulfite.

Pimozide should not be taken by anyone who:

• is sedated or in a comatose state
• has liver disorders
• has a depressive disorder
• has reduced kidney function
• has blood disorders
• has an allergy to pimozide or any of the ingredients of the medication
• has Parkinson's disease
• has certain types of abnormal heart rhythms
• has low blood potassium or magnesium levels
• has a severely reduced heart rate
• is taking any of the classes of medications known as "azole"-antifungals, antiviral protease inhibitors, or macrolide antibiotics (erythromycins)
• is taking nefazodone or quinidine

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medication; check with your doctor if they continue or become bothersome.

More common:

• blurred vision or other vision problems
• constipation
• dizziness, lightheadedness, or fainting when rising from a lying or sitting position
• drowsiness
• dryness of mouth
• skin discoloration

  Less common:

• decreased sexual ability
• depression
• diarrhea
• headache
• loss of appetite and weight
• nausea and vomiting
• tiredness or weakness

Contact your doctor as soon as possible if any of the following side effects occur:

More common:

• difficulty speaking
• dizziness or fainting
• fast or irregular heartbeat
• loss of balance control
• lack of facial expression
• mood or behaviour changes
• restlessness or need to keep moving
• shuffling walk
• slowed movements
• stiffness of arms and legs
• swelling or soreness of breasts (less common in males)
• trembling and shaking of fingers and hands
• unusual secretion of milk (rare in males)

  Less common or rare:

• difficulty swallowing
• inability to move eyes
• increased blinking or spasms of eyelid
• lip smacking or puckering
• menstrual changes
• muscle spasms, especially of the face, neck, or back
• puffing of cheeks
• rapid or worm-like movements of tongue
• skin rash and itching
• sore throat and fever
• swelling of face
• uncontrolled chewing movements
• uncontrolled movements of neck, trunk, arms, or legs, including twisting movements
• unusual bleeding or bruising
• unusual facial expressions or body positions
• yellow eyes or skin

Stop taking this medication and get emergency help immediately if any of the following side effects occur:

Rare - usually two or more occur together:

• convulsions (seizures)
• difficult or unusually fast breathing
• fast heartbeat or irregular pulse
• fever (high)
• high or low (irregular) blood pressure
• increased sweating
• loss of bladder control
• muscle stiffness (severe)

  Symptoms of overdose:

• coma
• convulsions (seizures)
• dizziness (severe)
• muscle trembling, jerking, or stiffness (severe)
• troubled breathing (severe)
• uncontrolled movements (severe)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Blood pressure: People who take pimozide may develop very low blood pressure causing dizziness and lightheadedness. Some individuals, especially seniors or those who are debilitated, have had temporary low blood pressure for several hours after taking the medication.

Epilepsy: Since pimozide may lower the convulsive (seizure) threshold, it should be used with caution by people with epilepsy.

Grapefruit juice: Grapefruit juice prevents pimozide from being broken down (metabolized) in the body. Avoid drinking grapefruit juice if you take pimozide.

Liver disease: People with liver disease should use caution while taking this medication because pimozide is broken down (metabolized) in the liver.

Occupational hazards: Pimozide may reduce alertness, especially at the start of treatment. Alcohol may increase these effects. Avoid tasks requiring alertness, such as driving or operating machinery, until you determine if the medication affects you this way.

Tardive dyskinesia: As with all antipsychotic medications, a syndrome called tardive dyskinesia may appear for some people on long-term therapy or after they stop taking the medication. The syndrome's main features are rhythmical involuntary movements of the tongue, face, mouth, or jaw. Tell the doctor if you notice these symptoms in yourself or someone else taking pimozide.

Pregnancy: The safe of use of pimozide during pregnancy has not been established. It should not be taken by women who are or may become pregnant, particularly during the first trimester of pregnancy, unless, in the opinion of the doctor, the expected benefits outweigh the potential risks.

Breast-feeding: Pimozide may pass into breast milk. If the use of pimozide is considered essential, stop breast-feeding.

Children: The safety and effectiveness of this medication have not been established for use by children. Its use by this age group is not recommended.

Pimozide may affect the way the following medications work:

• amphetamines (e.g., dextroamphetamine)
• anesthetics (e.g., halothane)
• medications that lower blood pressure
• levodopa

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.