Orap (pimozide)

Orap (pimozide)
Brand name: Orap®
Active ingredient name: Pimozide
Type of drug: Typical antipsychotic
Form: Oral tablets
Brand name available in Canada from: MM Therapeutics Inc.
Generic: Yes: Apo-Pimozide (Apotex Inc.); PMS-Pimozide (Pharmascience Inc.)
Listed on Ontario formulary: Yes


What is Orap used for?
Orap is used to treat symptoms of schizophrenia and other psychotic illnesses in adults.  Some research suggests individuals with autism and schizophrenia do very well with pimozide treatment. Orap may also be used to treat Tourette’s Syndrome in children.

 
How much Orap should I take?
Orap is available in 2 and 4 mg tablets. It is given once daily.

The usual dosage range for Orap for schizophrenia and other psychotic illnesses is 2-12 mg per day.  The most common daily dose is 6 mg per day.  Doses above 20 mg are not recommended.

 
What are the common side effects seen with Orap? 
  • Abnormal movements (extrapyramidal symptoms)
  • Changes in menstrual cycle
  • Decrease in sexual interest and/or function
  • Swelling of the breasts and milk production in both men and women
  • Decreased weight
  • Dry mouth
  • Nausea
  • Headache
  • Difficulty sleeping (insomnia)
In addition to the above physical side effects, Orap can also cause mood side effects.  Some individuals may develop low mood or depression while on Orap.  In addition some individuals may also describe feeling a sense of unease, dissatisfaction with life, indifference or unhappiness. If your mood or feelings change while taking Orap inform your doctor. Your doctor will assess you to determine if you are experiencing side effects from the medication or symptoms from your illness. 

What are rare, but potentially serious side effects seen with Orap?
  • Decreased white blood cell count (agranulocytosis)
  • Drug induced lupus
  • Anaphylactic reaction (severe allergy)
  • Torsades de Pointes (a serious heart arrhthymia)
  • Neuroleptic malignant syndrome (NMS)
 
Warnings/Precautions
Elderly individuals with dementia-related psychosis treated with antipsychotic medication are at an increased risk of death compared to individuals not receiving antipsychotics.  Most deaths appear to be either cardiovascular or infectious. Orap is not approved for the treatment of dementia-related psychosis.  Some individuals with dementia may however be treated with this medication. Discuss the potential risks and benefits of this medication with your doctor for this indication.

 
What medications interact with Orap?
Tell all your doctors, pharmacists, and dentist that you are taking Orap. You should also tell your doctor or pharmacist if you are taking any other medications, including those obtained without a prescription and herbal or vitamin products.

 
Orap has the potential for several significant drug interactions.  It is very important to be sure to inform your doctor and pharmacist of all medications you are taking if you are on Orap.
 
The following classes and/or individual medications might interact with Orap:
  • Amiodarone (antiarrhythmic)
  • Certain medications for HIV infection
  • Other antipsychotic medication  (typical and atypical)
  • Certain Antidepressants (amitriptyline, desipramine, citalopram, escitalopram, fluoxetine, paroxetine, nortriptyline, sertraline)
  • Certain antibiotics (clarithromycin, ciprofloxacin, erythromycin, levofloxacin)
  • Antifungals (fluconazole, ketoconazole)
  • Grapefruit juice
Avoid drinking alcohol or using illegal drugs while taking Orap
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