Section 03 · Monograph

Pimozide

Reviewed Nov 2026FDA label

OrapTypical antipsychotic

Forms: Tab: 1, 2mg
Dose: Tourette's: start 1-2mg/day divided, increase every other day; max 0.2mg/kg or 10mg/day | Age 12+: start 0.05mg/kg qHS, increase every 3 days | CYP2D6 genotyping if above 4mg/day (adults)
MOA: D2 receptor blockade (tic suppression); QT prolongation risk

Indications

Suppression of motor and phonic tics in patients with Tourette's disorder who have failed standard treatmentFDA-labeled

Diphenylbutylpiperidine antipsychotic with potent dopamine D2 receptor blockade, suppressing motor and phonic tics

Adults: start 1-2mg/day in divided doses; increase every other day as tolerated; maintenance usually under 0.2mg/kg or 10mg/day
Age 12 and older: start 0.05mg/kg at bedtime; increase every 3 days to a maximum of 0.2mg/kg, not exceeding 10mg/day
CYP2D6 genotyping is recommended if the dose exceeds 4mg/day (adults); poor metabolizers should not exceed 4mg/day and dose increases should be at least 14 days apart
Obtain a baseline ECG; withdraw gradually

Tics other than Tourette's
Congenital long QT syndrome, history of arrhythmias, or concomitant QT-prolonging drugs
Hypokalemia or hypomagnesemia
Concomitant strong CYP3A4 inhibitors (macrolides such as clarithromycin and azole antifungals)
Severe toxic CNS depression or comatose states; hypersensitivity

QT-prolonging drugs and strong CYP3A4 inhibitors (macrolides, azoles, grapefruit juice) are contraindicated
CYP2D6 inhibitors (paroxetine, fluoxetine) raise levels
Additive CNS depression with other sedatives