Pimozide 4mg

Pimozide, Orap
Description: First Generation (Typical) Antipsychotic

CSA NA – FDA Approved – REMS (N) – Can Ship

Pimozide, Orap Pimozide is a potent centrally-acting dopamine-receptor antagonist resulting in its characteristic neuroleptic effects.

Tourette disorder

starting Pimozide, Orap make sure your physician is aware of any allergies or medications you currently take, if you have cardiovascular disease, dementia, a depressive disorder, Parkinson disease, pheochromocytoma, hepatic impairment, renal impairment, a seizure disorder, are a poor CYP2D6 metabolizer, are pregnant, or breastfeeding. Pimozide, Orap use has been associated with rare but serious adverse events such as altered cardiac conduction, QT prolongation, anticholinergic effects, blood dyscrasias, CNS depression, esophageal dysmotility, aspiration, extrapyramidal symptoms, hyperprolactinemia, neuroleptic malignant syndrome, and temperature dysregulation.

Oral: Initial: 1 to 2 mg/day in divided doses, then increase dosage as needed every other day; maximum dose: 10 mg/day or 0.2 mg/kg/day (whichever is less)

How to Take: May be administered without regard to meals but is preferable to administer dose at bedtime.  If therapy requires exceeding dose of 4 mg/day, CYP2D6 geno-/phenotyping should be performed as CYP2D6 poor metabolizers must be tirtrated more slowly and should not exceed 4 mg/day.

You Need to Avoid:  Significant drug interactions exist, requiring dose/frequency adjustment or avoidance so avoid starting any new medications without consulting prescriber.   Do not stop this medication suddenly, make sure your physician is aware and can create a tapering schedule so you can come off slowly and prevent any withdrawal symptoms.

Sedation, akathisia, drowsiness, behavioral changes, hypertonia, xerostomia, constipation, impotence, akinesia, weakness, decreased accommodation, visual disturbance

Note this is not a complete list of side effects, only the most common

1. What do I do if side effects are intolerable?
   If side effects are causing a lot of distress speak to your physician as soon as possible to discuss options.
2. Why would my physician prescribe a medication with such serious side effects?
   Your physician takes the most recent clinical guidelines to make evidence-based decisions on what medication is appropriate in which situations.  Your current medications, your allergies, age, cost of medication, comorbid conditions and many other factors will further complicate or limit which medications are appropriate.  This medication is used for certain forms of cancer and your physician has determined the benefits outweigh the risks.  Furthermore, they will be monitoring your bloodwork and symptoms closely to avoid many of the serious side effects and will keep you on the lowest effective dosage for the shortest amount of time possible.
3. What are extra-pyramidal reactions?
   Blocking dopamine in the extra-pyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders.  This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities).  These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine.  If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
4. What is Neuroleptic Malignant Syndrome?
   NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly.  Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status.  As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures.  Seek medical attention immediately if this reaction is suspected.