Children and Adolescents

• Safety and efficacy established for patients over age 12

• Preliminary data show similar safety for patients age 2–12 as for patients over 12

• Generally use second-line after atypical antipsychotics and other conventional antipsychotics

Pregnancy

• Risk Category C [some animal studies show adverse effects; no controlled studies in humans]

• Renal papillary abnormalities have been seen in rats during pregnancy

• No studies in pregnant women

• There is a risk of abnormal muscle movements and withdrawal symptoms in newborns whose mothers took an antipsychotic during the third trimester; symptoms may include agitation, abnormally increased or decreased muscle tone, tremor, sleepiness, severe difficulty breathing, and difficulty feeding

• Psychotic symptoms may worsen during pregnancy and some form of treatment may be necessary

• Atypical antipsychotics may be preferable to conventional antipsychotics or anticonvulsant mood stabilizers if treatment is required during pregnancy

• Should evaluate for an antipsychotic with a better risk/benefit ratio if treatment required during pregnancy

Breast Feeding

• Unknown if pimozide is secreted in human breast milk, but all psychotropics assumed to be secreted in breast milk

• Not recommended for use because of potential for tumorigenicity or cardiovascular effects on infant

✽ Recommended either to discontinue drug or bottle feed

PIMOZIDE: THE ART OF PSYCHOPHARMACOLOGY

Potential Advantages

• Only for patients who respond to this agent and not to other antipsychotics

Potential Disadvantages

• Vulnerable populations such as children and elderly

• Patients on other drugs

Primary Target Symptoms

• Vocal and motor tics in patients who fail to respond to treatment with other antipsychotics

• Psychotic symptoms in patients who fail to respond to treatment with other antipsychotics

Pearls

✽ In the past, was a first-line choice for Tourette’s syndrome and for certain behavioral disorders, including monosymptomatic hypochondriasis; however, it is now recognized that the benefits of pimozide generally do not outweigh its risks in most patients

✽ Because of its effects on the QTc interval, pimozide is not intended for use unless other options for tic disorders (or psychotic disorders) have failed

Suggested Reading

Pringsheim T, Marras C. Pimozide for tics in Tourette’s syndrome. Cochrane Database Syst Rev 2009;15(2):CD006996.

Rathbone J, McMonagle T. Pimozide for schizophrenia or related psychoses. Cochrane Database Syst Rev 2007;18(3):CD001949.

PIPOTHIAZINE

PIPOTHIAZINE: THERAPEUTICS

Brands

• Piportil

see index for additional brand names

Generic?

No

Class

• Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist)

Commonly Prescribed for

(bold for FDA approved)

• Maintenance treatment of schizophrenia

• Other psychotic disorders

• Bipolar disorder

How the Drug Works

• Blocks dopamine 2 receptors, reducing positive symptoms of psychosis

How Long Until It Works

• Psychotic symptoms can improve within 1 week, but it may take several weeks for full effect on behavior

If It Works

• Most often reduces positive symptoms in schizophrenia but does not eliminate them

• Most schizophrenic patients do not have a total remission of symptoms but rather a reduction of symptoms by about a third

• Continue treatment in schizophrenia until reaching a plateau of improvement

• After reaching a satisfactory plateau, continue treatment for at least a year after first episode of psychosis in schizophrenia

• For second and subsequent episodes of psychosis in schizophrenia, treatment may need to be indefinite

• Reduces symptoms of acute psychotic mania but not proven as a mood stabilizer or as an effective maintenance treatment in bipolar disorder

• After reducing acute psychotic symptoms in mania, switch to a mood stabilizer and/or an atypical antipsychotic for mood stabilization and maintenance