Orap Disease Interactions
There are 18 disease interactions with Orap (pimozide).
- Dementia
- CNS depression/coma
- Previous neuroleptic malignant syndrome (NMS)
- Seizure disorders
- Acute alcohol intoxication
- CNS depression
- NMS
- Pituitary tumors
- QT interval prolongation
- Tics
- Seizure
- Hyperprolactinemia/breast cancer
- Neutropenia
- Anticholinergic effects
- Hyperprolactinemia
- Parkinsonism
- Tardive dyskinesia
- Renal/liver disease
Atypical antipsychotic agents (applies to Orap) dementia
Major Potential Hazard, High plausibility.
Antipsychotic drugs are not approved for the treatment of patients with dementia-related psychosis. Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo.
Miscellaneous antipsychotics (applies to Orap) CNS depression/coma
Major Potential Hazard, Moderate plausibility. Applicable conditions: Altered Consciousness, Acute Alcohol Intoxication
The use of most miscellaneous antipsychotics is contraindicated in patients with severe central nervous system depression or comatose states from any cause (e.g., lesion, disease, drug or alcohol induced).
Miscellaneous antipsychotics (applies to Orap) previous neuroleptic malignant syndrome (NMS)
Major Potential Hazard, Moderate plausibility.
Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex, has been reported in association with the use of antipsychotic drugs. The diagnostic evaluation is complicated and the management requires immediate discontinuation of the antipsychotic therapy and intensive symptomatic treatment and medical monitoring. If a patient that has recovered from NMS requires antipsychotic drug treatment again, the reintroduction of therapy should be carefully considered as NMS recurrences have been reported.
Miscellaneous antipsychotics (applies to Orap) seizure disorders
Major Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder, Alcoholism
Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.
Neuroleptics (applies to Orap) acute alcohol intoxication
Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism
The use of neuroleptic agents is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of neuroleptic agents may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with neuroleptic agents should be administered cautiously in patients who might be prone to acute alcohol intake.
Neuroleptics (applies to Orap) CNS depression
Major Potential Hazard, High plausibility. Applicable conditions: Altered Consciousness, Respiratory Arrest
The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.
Neuroleptics (applies to Orap) NMS
Major Potential Hazard, High plausibility. Applicable conditions: Neuroleptic Malignant Syndrome
The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.
Pimozide (applies to Orap) pituitary tumors
Major Potential Hazard, Moderate plausibility.
Pimozide may have a tumorigenic potential and has been shown to cause a dose-related increase in pituitary tumors in mice. When treated for up to 18 months, pituitary gland changes that occurred were characterized as hyperplasia at doses approximating the human dose and adenoma at doses about 15 times the maximum recommended human dose on a mg/kg basis. The full significance of this finding is unknown but should be considered when prescribing pimozide, particularly in patients with preexisting pituitary tumors.
Pimozide (applies to Orap) QT interval prolongation
Major Potential Hazard, Moderate plausibility. Applicable conditions: Hypokalemia, Electrolyte Abnormalities, Arrhythmias, Diarrhea, Magnesium Imbalance, Abnormal Electrocardiogram
The use of pimozide is contraindicated in patients with congenital or acquired QT interval prolongation syndromes or a history of cardiac arrhythmias. Pimozide can prolong the QT interval of the electrocardiogram. The risk of torsade de pointes is progressively increased as the degree of prolongation becomes greater. Electrolyte disturbances such as hypokalemia and hypomagnesemia may augment the prolongation effect of pimozide on the QT interval and should be corrected prior to institution of pimozide therapy. In addition, patients who experience frequent, severe, or prolonged diarrhea may be subject to electrolyte losses and should be followed closely and managed accordingly during therapy with pimozide. Because sudden deaths have been reported in patients using pimozide, and electrocardiogram should be performed before starting treatment and periodically thereafter, especially during periods of dose adjustment.
Pimozide (applies to Orap) tics
Major Potential Hazard, Moderate plausibility. Applicable conditions: Tic Disorder
Pimozide is contraindicated in the treatment of simple tics or tics other than those associated with Tourette's Disorder.
Antipsychotic/neuroleptic agents (applies to Orap) seizure
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism, Head Injury, Seizures
Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.
Miscellaneous antipsychotics (applies to Orap) hyperprolactinemia/breast cancer
Moderate Potential Hazard, Moderate plausibility.
Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.
Miscellaneous antipsychotics (applies to Orap) neutropenia
Moderate Potential Hazard, Moderate plausibility.
The use of antipsychotics has been associated with events of leukopenia, neutropenia and agranulocytosis. Possible risk factors include preexisting low white blood cell count, and history of drug induced leukopenia/neutropenia. Patients with these risk factors should have complete blood count monitored frequently during the first few months of therapy. Patients should also be monitored for any signs or symptoms of infection. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count or severe neutropenia (ANC < 1000/mm3).
Neuroleptics (applies to Orap) anticholinergic effects
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention
Most neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low- potency agents such as chlorpromazine and thioridazine tend to exhibit the greatest degree of anticholinergic effects in the class, while haloperidol as well as the newer, atypical agents like quetiapine, risperidone and ziprasidone have generally been associated with very low frequencies of anticholinergic adverse effects. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.
Neuroleptics (applies to Orap) hyperprolactinemia
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Breast Cancer
The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels due to antagonism of dopamine D2 receptors. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer. Caution is also advised in patients with preexisting hyperprolactinemia. Hyperprolactinemia may suppress hypothalamic gonadotrophin releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds; however, the clinical significance of elevated serum prolactin levels is unknown for most patients. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients.
Neuroleptics (applies to Orap) parkinsonism
Moderate Potential Hazard, High plausibility.
The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects, and their use may be contraindicated in patients with Parkinson's disease or parkinsonian symptoms.
Neuroleptics (applies to Orap) tardive dyskinesia
Moderate Potential Hazard, High plausibility.
Tardive dyskinesia (TD) has occurred in patients treated with antipsychotic drugs; the syndrome consists of potentially irreversible, involuntary, dyskinetic movements. The risk appears highest in older patients (particularly older women) but it is not possible to predict which patients are likely to develop TD; whether antipsychotic drugs differ in their potential to cause TD is unknown. The risk of TD and the likelihood that it will become irreversible increase with the duration of therapy and the total cumulative dose. The syndrome can develop after relatively brief treatment periods, even at low dosages; it may also occur after discontinuation of therapy. TD may remit (partially or completely) upon discontinuation of antipsychotic therapy, although antipsychotic therapy itself may suppress (or partially suppress) signs/symptoms of TD, possibly masking the underlying process; the effect of symptomatic suppression on the long-term course of TD is unknown. In patients with preexisting drug-induced TD, initiating or increasing the dosage of antipsychotic therapy may temporarily mask the symptoms of TD but could eventually worsen the condition. In patients requiring chronic therapy, the lowest dose and shortest duration of therapy producing a satisfactory clinical response are recommended; the need for continued therapy should be reassessed periodically. If signs/symptoms of TD occur during antipsychotic therapy, discontinuation of the offending agent should be considered; however, some patients may require treatment despite the presence of TD.
Pimozide (applies to Orap) renal/liver disease
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction
Pimozide is extensively metabolized by the liver, and both parent drug and metabolites are eliminated by the kidney. Patients with impaired renal and/or hepatic function may be at greater risk for adverse effects due to drug and metabolite accumulation. Therapy with pimozide should be administered cautiously in such patients.
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Orap drug interactions
There are 749 drug interactions with Orap (pimozide).
Orap alcohol/food interactions
There is 1 alcohol/food interaction with Orap (pimozide).
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Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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