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Pimozide (Orap®)

Pimozide (Orap® and generic forms) belongs to a group of medications called first- generation antipsychotics or “traditional antipsychotics.”

What is this medication used for?

Pimozide was first developed to treat psychotic illnesses such as schizophrenia in adults. Pimozide is not approved by Health Canada for use in children and adolescents.

However, when potential benefits outweigh risks, pimozide may be prescribed “off-label” for children age 2 years or older for the treatment of Tourette syndrome or motor and/or vocal tics. Learn more about off-label medication use:

Tell your doctor or pharmacist if you:

  • Have allergies or bad reactions to a medication
  • Take (or plan to take) other prescription or non- prescription medications, including natural medicines. Some medications interact with pimozide. Your doctor may adjust medication doses or monitor for side effects
  • Are lactose intolerant
  • Have a history of kidney or liver disease, epilepsy or seizures, trouble urinating or glaucoma
  • Have a history (or family history) of heart disease, arrhythmia or “familial long QT syndrome”
  • Miss a menstrual period, are pregnant, breastfeeding or planning a pregnancy
  • Use alcohol or drugs. Taking pimozide together with certain substances may cause a bad reaction. Learn more at

When will the medication start to work?

Improvements may be seen within 1 to 2 weeks. However, it can take up to 6 weeks to see the full benefits of this medication.

It is important that you continue taking pimozide regularly, even if you are feeling well or there are no improvements in the first few weeks. Talk with your doctor if you feel that pimozide has not been helpful or if side effects are too bothersome. Your doctor may recommend switching you to a different medication.

This medication is not addictive. Do not stop taking it before talking to your doctor.

How do I take this medication?

Pimozide is usually taken once a day at bedtime, with or without food. Usually, you will start with a low dose of and slowly increase this dose over several days or weeks, based on how you tolerate it.

Pimozide is available in tablets that are taken by mouth. If necessary, tablets may be broken in half, but they should not be crushed or chewed. Pimozide may interact with grapefruit. While taking this medication, avoid eating grapefruit or drinking grapefruit juice as this may lead to increased side effects.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

  • Dizziness, drowsiness or headache
  • Feelings of agitation or restlessness
  • Stomach ache or constipation
  • Increased appetite or weight gain
  • Blurred vision or dry mouth
  • Muscle stiffness or muscle spasm
  • Increased blood glucose or cholesterol levels

Contact your doctor immediately if you experience:

  • Unexplained rash, seizure, fever or excessive sweating
  • Fainting, feeling lightheaded or difficulty with balance
  • Breast tenderness or swelling (males and females)
  • Feelings of restlessness, fast or irregular heartbeat
  • Shaking, pain or weakness
  • Unusual movements of fingers, toes, neck, lips or tongue
  • Unexplained confusion

What precautions should my doctor and I be aware of when taking this medication?

  • When you take this medication, your body may have difficulty maintaining a normal body temperature. Drink enough fluids to avoid becoming dehydrated. Avoid doing a lot of physical activity on hot days.
  • While taking this medication, if you feel dizzy, drowsy or slowed down, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking pimozide.
  • Pimozide can cause a rare side effect called “tardive dyskinesia.” Symptoms include involuntary movements of the lips, tongue, toes, hands or neck.
  • Stopping or switching this medication at first signs will decrease the chances this side effect will continue. These movements may become permanent without a medication change.
  • Pimozide can cause a rare side effect called “neuroleptic malignant syndrome.” Symptoms include severe muscle stiffness, high fever, sweating, increased or irregular heart beat and decreased blood pressure.

What special instructions should I follow while using this medication?

  • Keep all appointments with your doctor and the lab. Your doctor may order lab tests to check how you are responding and monitor for side effects.
  • Try to keep a healthy, well-balanced diet and exercise regularly. Some people may gain weight as a result of increased appetite.
  • Wear sunscreen and sunglasses as this medication increases sensitivity to the sun.
  • Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you take pimozide regularly and forget to take a dose, take the missed dose as soon as you remember. However, if it is within 4 hours of your next scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch up’.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

How does this medication work?

Pimozide affects actions of the brain chemical dopamine. The exact way that pimozide improve symptoms of Tourette syndrome, schizophrenia and other conditions is not known.

How well does the medication work in children and adolescents?

Current evidence supports the use of pimozide for the treatment of Tourette syndrome in children and adolescents. It has been shown to reduce the number of motor and vocal tics, as well as the severity of symptoms. It is generally used after other treatments for Tourette syndrome are found to be ineffective or intolerable. However, medication treatment choices can vary depending on the individual situation. Whenever possible, adding behavioural therapy and counselling to pimozide treatment may increase the chance for benefit. Pimozide has been used along with stimulants in the management of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with Tourette syndrome.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Most people with Tourette syndrome or tic disorders need to take pimozide for several months. This allows time for symptoms to stabilize and for function to improve. Your doctor will discuss the benefits and risks of taking pimozide with you. At this time, you can also discuss how long you might need to take the medication.

Do not increase, decrease, or stop taking these medications without discussing it with your doctor. If you stop taking the medication suddenly, it is possible that your symptoms may return or you may have a bad reaction.

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