pimozide

Antipsychotic

Brands: Orap

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is pimozide?
Pimozide (brand Orap) is an antipsychotic-class dopamine receptor antagonist used primarily for tic suppression in Tourette’s disorder. The label states it is not a first-choice treatment and is reserved for patients whose daily functioning is severely compromised after inadequate response to standard treatment (label).
What is Orap?
Orap is a brand name for pimozide.
What is Orap (pimozide) used for?
Label indications include: Tourette’s disorder — suppression of motor and phonic tics after inadequate response to standard treatment (label).
What drug class is Orap (pimozide)?
Antipsychotic.
What is the mechanism of action of Orap (pimozide)?
Dopamine receptor antagonist used primarily for Tourette’s disorder (tic suppression). Carries QT prolongation risk and has extensive contraindicated drug interactions (label).
What strengths does Orap (pimozide) come in?
Tablets: 1 mg and 2 mg (label/manufacturer-dependent).
Is Orap (pimozide) a controlled substance?
No — it is not scheduled as a controlled substance under U.S. federal law.

Snapshot

Class: Antipsychotic
Common US brands: Orap
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Tourette’s disorder — suppression of motor and phonic tics after inadequate response to standard treatment (label).

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Clinical Highlights

Pimozide (brand Orap) is an antipsychotic-class dopamine receptor antagonist used primarily for tic suppression in Tourette’s disorder. The label states it is not a first-choice treatment and is reserved for patients whose daily functioning is severely compromised after inadequate response to standard treatment (label). Cardiac safety is central: pimozide prolongs the QT interval, has many contraindicated combinations, and labeling calls for a baseline ECG and periodic ECGs, especially during dose adjustment (label).

The label includes dose limits tied to CYP2D6 status at higher doses. Genotyping is described as required above certain thresholds (e.g., >4 mg/day in adults) because poor metabolizers have higher exposure and greater QT risk (label).
Like all antipsychotics, pimozide carries the class boxed warning for increased mortality in elderly patients with dementia-related psychosis (label). Tourette’s treatment is typically pediatric/young adult, but the class warning still applies.
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Dosing & Formulations

Oral tablets are commonly available as 1 mg and 2 mg strengths (label/manufacturer-dependent). The label emphasizes slow, gradual titration to balance tic suppression with adverse effects, along with ECG monitoring at baseline and during dose adjustment (label).

Adult Tourette dosing: label describes initiating 1–2 mg/day in divided doses, with increases every other day as needed. Most patients are maintained at <0.2 mg/kg/day or 10 mg/day (whichever is less); doses above those thresholds are not recommended (label).
Pediatric dosing (Tourette): label describes starting 0.05 mg/kg once daily (preferably at bedtime) and titrating every third day to a maximum of 0.2 mg/kg/day (not to exceed 10 mg/day) (label).

Monitoring & Risks

QT prolongation and torsades risk: baseline ECG, periodic ECGs (especially during titration), and attention to electrolytes are core monitoring elements (label). Contraindicated combinations include macrolide antibiotics and multiple QT-prolonging agents; pimozide is also contraindicated with citalopram and escitalopram due to QT interaction risk (label).

EPS and tardive dyskinesia can occur as with other dopamine-blocking agents; symptom screening is typical during dose changes (label/clinical).
Sedation can occur and additive CNS depression is a practical risk when combined with other sedatives (label/clinical).

Drug Interactions

The label describes extensive contraindicated QT-prolonging drug combinations and warns against adding macrolides because of both QT and metabolism effects (label). Because pimozide is metabolized in part by CYP3A4 and CYP2D6, strong inhibitors can increase exposure; drug–drug interaction review is central before dose escalation (label).

Pimozide is contraindicated with citalopram/escitalopram (Celexa/Lexapro) due to QTc increases observed in controlled study (label).

Practice Notes

Pimozide is generally framed as a “specialty” Tourette option with ECG-anchored monitoring and careful interaction review. Neurology and psychiatry co-management is common when dopamine-blocking agents are used for tics (Pringsheim 2019/clinical). The label discusses periodic attempts to reduce dose to determine if tics persist, recognizing that brief rebound tic worsening can occur after dose reduction (label).

References

Pimozide tablets prescribing information — DailyMed (2024)
Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders — Neurology (PMC) (2019)
Torsade de Pointes (StatPearls) — StatPearls Publishing (NCBI Bookshelf) (2025)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)