headache.hepatic disorders.hyperhidrosis.menstruation
with decreased bleeding.movement disorders.nasal
congestion.nausea.oculogyric crisis.oedema.paralytic
ileus.photosensitivity reaction.pigmented retinopathy.
reflexes increased.saliva altered.systemic lupus
erythematosus (SLE).temperature regulation disorder.
urinary hesitation.vision disorders
SIDE-EFFECTS, FURTHER INFORMATIONAcute dystonias are
more common with potentfirst-generation antipsychotics.
The risk is increased in men, young adults, children,
antipsychotic-naïve patients, rapid dose escalation, and
abrupt treatment discontinuation.lHEPATIC IMPAIRMENTCan precipitate coma;
phenothiazines are hepatotoxic.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe renal
impairment because of increased cerebral sensitivity.
lMEDICINAL FORMS
Forms available from special-order manufacturers include:
tablet, oral suspension
eiiiiF 244Pimozide
lINDICATIONS AND DOSE
Schizophrenia
▶BY MOUTH
▶Child 12–17 years (under expert supervision):Initially 1 mg
daily, adjusted according to response, then increased in
steps of 2 – 4 mg at intervals of not less than 1 week;
usual dose 2 – 20 mg daily
Tourette syndrome (under expert supervision)
▶BY MOUTH
▶Child 2–11 years: 1 – 4 mg daily
▶Child 12–17 years: 2 – 10 mg dailylUNLICENSED USENot licensed for use in Tourette
syndrome.
lCONTRA-INDICATIONSCNS depression.comatose states.
history of arrhythmias.history or family history of
congenital QT prolongation.phaeochromocytoma
lINTERACTIONS→Appendix 1 : pimozide
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.depression.
fatigue.headache.hyperhidrosis.hypersalivation.
lethargy.muscle complaints.restlessness.sebaceous
gland overactivity.urinary disorders.vision blurred.
vomiting
▶UncommonCogwheel rigidity.dysarthria.face oedema.
oculogyric crisis.skin reactions
▶Frequency not knownCardiac arrest.generalised tonic-
clonic seizure.glycosuria.hyponatraemia.libido
decreased.neck stiffness.temperature regulation
disorders
lHEPATIC IMPAIRMENTCan precipitate coma.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe renal
impairment because of increased cerebral sensitivity.
lMONITORING REQUIREMENTS
▶ECG monitoringFollowing reports of sudden unexplained
death, an ECG is recommended before treatment. It is also
recommended that patients taking pimozide should have
an annual ECG (if the QT interval is prolonged, treatment
should be reviewed and either withdrawn or dose reduced
under close supervision) and that pimozide should not be
given with other antipsychotic drugs (including depot
preparations), tricyclic antidepressants or other drugs
which prolong the QT interval, such as certain
antimalarials, antiarrhythmic drugs and certain
antihistamines and should not be given with drugs which
cause electrolyte disturbances (especially diuretics).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Pimozide (Non-proprietary)
Pimozide 4 mgPimozide 4 mg tablets| 100 tabletPsDT =
£ 40. 31
▶Orap (Imported (United States))
Pimozide 1 mgOrap 1 mg tablets| 100 tabletPs
▶Orap(Eumedica Pharmaceuticals)
Pimozide 4 mgOrap 4 mg tablets| 100 tabletP£ 40. 31 DT =
£ 40. 31
eiiiiF 244Sulpiride
lINDICATIONS AND DOSE
Schizophrenia with predominantly negative symptoms
▶BY MOUTH
▶Child 14–17 years (under expert supervision): 200 – 400 mg
twice daily; maximum 800 mg per day
Schizophrenia with mainly positive symptoms
▶BY MOUTH
▶Child 14–17 years (under expert supervision): 200 – 400 mg
twice daily; maximum 2. 4 g per day
Tourette syndrome (under expert supervision)
▶BY MOUTH
▶Child 2–11 years: 50 – 400 mg twice daily
▶Child 12–17 years: 100 – 400 mg twice dailylUNLICENSED USENot licensed for use in Tourette
syndrome.
lCONTRA-INDICATIONSCNS depression.comatose states.
phaeochromocytoma
lCAUTIONSAggressive patients (even low doses may
aggravate symptoms).agitated patients (even low doses
may aggravate symptoms).excited patients (even low
doses may aggravate symptoms)
lINTERACTIONS→Appendix 1 : sulpiride
lSIDE-EFFECTS
▶Common or very commonBreast abnormalities.sedation.
skin reactions
▶UncommonHypersalivation.muscle tone increased.
postural hypotension
▶Rare or very rareOculogyric crisis
▶Frequency not knownCardiac arrest.dyspnoea.
hyponatraemia.SIADH.trismus
lHEPATIC IMPAIRMENTCan precipitate coma.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe renal
impairment because of increased cerebral sensitivity.
lMONITORING REQUIREMENTSSulpiride does not affect
blood pressure to the same extent as other antipsychotic
drugs and so blood pressure monitoring is not mandatory
for this drug.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral liquid formulations may include lemon and aniseed.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Sulpiride for schizophrenia and
Tourette’s syndromewww.medicinesforchildren.org.uk/
sulpiride-for-schizophrenia-and-tourettes-syndromeBNFC 2018 – 2019 Psychoses and schizophrenia 247
Nervous system4