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PubMed1983

Mechanisms involved in the blocking effects of pimozide on smooth muscle contraction.

Pimozide, a dopamine-receptor antagonist, shifted to the right the concentration-response curves (CRC) induced by (-)-noradrenaline in the isolated posterior mesenteric artery of the cat. Since this antagonism could be related to a blockade of vascular alpha-adrenoceptors, we compared the effects of pimozide (0.20 microM) with those of phentolamine (0.31 microM). The onset of the blockade by pimozide on the (-)-noradrenaline-induced contractions was slower when compared with that of phentolamine. In addition, the effects of pimozide did not reverse by washing while those of phentolamine did. Pimozide but not phentolamine inhibited the contractions elicited by potassium and it decreased the maximum responses of the curves. This effect was partially reversed by CaCl2 10.2 mM. Pimozide displaced the CRC induced by CaCl2 to a greater extent than phentolamine. Even if a blocking effect on alpha-adrenoceptors cannot be discarded, our results suggest that pimozide may interfere with calcium in the arterial smooth muscle. Furthermore, vascular smooth muscle seems to be more sensitive than non-vascular tissue to the action of pimozide.

Animals↗
PubMed2000

Studies on the mechanism of a fatal clarithromycin-pimozide interaction in a patient with Tourette syndrome.

The authors report in detail the case of a 27-year-old man who experienced sudden cardiac death 2 days after coprescription of the neuroleptic pimozide and the macrolide antibiotic clarithromycin after the documentation of a prolonged QT interval. To determine the prevalence of this interaction, the authors referred to the Spontaneous Reporting System of the Food and Drug Administration and identified one similar case in which clarithromycin was coprescribed with pimozide and sudden cardiac death occurred shortly thereafter. In addition, the search identified 39 cases of cardiac arrhythmia associated with pimozide, 11 with pimozide alone, and 6 with clarithromycin alone, 1 of which had a positive rechallenge. The mechanism of the interaction between clarithromycin and pimozide seems to involve the inhibition of the hepatic metabolism of pimozide by the macrolide. The authors demonstrated that clarithromycin is able to inhibit the metabolism of pimozide in human liver microsomal preparations (K(i) = 7.65 +/- 1.18 microM) and that pimozide, but not clarithromycin or its primary metabolite, is able to prolong the electrocardiac QT interval in a dose-dependent manner in the isolated perfused rabbit heart. The increase was 9.6 +/- 1.1% in male hearts (N = 5) and 13.4 +/- 1.2% in female hearts (N = 4) (p < 0.05).

Adolescent↗
PubMed2002

The Ca(2+) channel antagonists mibefradil and pimozide inhibit cell growth via different cytotoxic mechanisms.

We show that mitogenic cells expressing T-type Ca(2+) channels (T-channels) are more sensitive to the antiproliferative effects of the drugs pimozide and mibefradil than cells without significant T-channel expression. The growth of Y79 and WERI-Rb1 retinoblastoma cells, as well as MCF7 breast cancer epithelial cells, all of which express T-channel current and mRNA for T-channel subunits, is inhibited by pimozide and mibefradil with IC(50) values between 0.6 and 1.5 microM. Proliferation of glioma C6 cells, which show little T-channel expression, is less sensitive to these drugs (IC(50) = 8 and 5 microM for pimozide and mibefradil, respectively). Neither drug seems to alter cell cycle or the expression of cyclins. Although this strong correlation between T-channel expression and growth inhibition exists, the following results suggest that the drugs inhibit cell growth via different cytotoxic pathways: 1) pimozide and mibefradil have additive effects on T-channel current inhibition, whereas the antiproliferative activity of the drugs together is synergistic; 2) an increase in the number of apoptotic Y79 and MCF7 cells and a decrease in the mRNA for the antiapoptotic gene Bcl-2 is detected only in pimozide-treated cells, whereas in mibefradil-treated cells, the toxicity is primarily necrotic; and 3) growth inhibition by mibefradil is reduced in Y79 cells transfected with T-channel antisense and in differentiated Y79 cells (which have decreased T-channel expression), but growth inhibition by pimozide is affected to a lesser extent. These results suggest that pimozide and mibefradil inhibit cell proliferation via different cytotoxic pathways and that in the case of pimozide, it is unlikely that this effect is mediated solely by T-channel inhibition.

Antineoplastic Agents↗
PubMed1982

Comparison of pimozide and chlorpromazine in acute schizophrenia.

A four week double-blind study comparing pimozide and chlorpromazine was designed to test the hypothesis that pimozide, a powerful dopamine receptor blocker, is more effective in the treatment of acute schizophrenia than chlorpromazine. Twenty patients, 13 males and 7 females ranging in age from 21 to 53 years (mean age 33 years) admitted to ST. Mary's Hospital with acute schizophrenia were placed on the study. They were treated on an individual titrated dosage of either chlorpromazine 300 mg to 2100 mg, or pimozide 10 to 70 mg. The results revealed that on the Brief Psychiatric Rating Scale, the chlorpromazine group significantly improved after one week, whereas the pimozide group showed no statistical improvement until the third week. By the end of the study no significant differences were apparent between the two groups. In the Clinical Global Impression Scale, a significant difference between the two groups was found at week 4 showing a greater improvement in the chlorpromazine group. In terms of adverse reactions, the chlorpromazine group had significantly fewer extrapyramidal symptoms than the pimozide group (Simpson and Angus Scale) and in addition 15 adverse reactions were noted for the pimozide group as compared with 8 for the chlorpromazine group. This study shows that chlorpromazine has an earlier onset of action than pimozide in the acute schizophrenic patient despite the fact that it has a weaker effect on the dopamine receptor than has pimozide. In view of this finding, the dopamine theory of schizophrenia should be critically re-examined.

Acute Disease↗
PubMed1985

Seasonal effects of pimozide and des Gly10 [D-Ala6] LH-RH ethylamide on gonadotrophin secretion in goldfish.

The seasonal changes in the gonadotrophin-release-inhibitory activity of dopamine and responsiveness to gonadotrophin-releasing hormone were investigated by determining the effects of injection of pimozide, a dopamine receptor antagonist, des-Gly10 [D-Ala6] LH-RH ethylamide (LRH-A), or the combination of pimozide plus LRH-A on serum gonadotrophin (GtH) levels of goldfish, held at 12 or 20 degrees C, at different stages of gonadal development. As in previous studies, pimozide greatly potentiated the GtH-release response to LRH-A. The highest concentrations of serum GtH induced by injection of pimozide or LRH-A alone, or the combination of pimozide plus LRH-A were in females in late stages of ovarian recrudescence; fish that were sexually regressed (males and females combined) were the least responsive, and fish that were in early stages of gonadal recrudescence, and mature females ( = prespawning, completed ovarian recrudescence) were intermediate. Fish held at 20 degrees C had a more rapid onset of GtH release and had higher serum GtH levels initially compared to fish at 12 degrees C at similar sexual stages; however, the fish held at 12 degrees C generally had a more prolonged increase in serum GtH levels, indicating that temperature influence the time course of the GtH-release response. The results indicate that there is a seasonal variation in responsiveness to injection of pimozide, LRH-A and the combination of pimozide plus LRH-A. These seasonal changes may be due to differences in the pituitary content of GtH, the ability of the pituitary to synthesize GtH, or changes in GtH cell receptors for GnRH and dopamine, or a combination of these and other unknown factors.

Animals↗
PubMed1994

Context-specific sensitization to naloxone-precipitated withdrawal in hamsters: effect of pimozide.

Three experiments were conducted to investigate the development of context-specific sensitization to naloxone-precipitated withdrawal in hamsters. In Experiment 1, animals in group M/S were given morphine (15 mg/kg) injections in a distinctive environment and saline in the home cage. Animals in group S/M were given saline in the distinctive environment and morphine in the home cage, and animals in group S/S were given saline in both environments. All groups were challenged subsequently with naloxone (0.4 mg/kg) in the distinctive environment and then observed for signs of opiate withdrawal. The results showed that group M/S gave more naloxone-precipitated withdrawal signs than each of the other groups, which did not differ from one another. Experiment 2 was designed to test the effect of pimozide on context-specific sensitization to naloxone-precipitated withdrawal. The design was similar to that of Experiment 1 but group P/M/S, which received an injection of pimozide (0.5 mg/kg) 4 h prior to morphine, was added. The results indicated that context-specific sensitization developed as in Experiment 1, except among animals treated with pimozide. Experiment 3 was designed to determine whether pimozide interferes with the development or the expression of context-specific sensitization. Six groups, differing in the frequency and timing of the pimozide injection, were employed. The results indicated that pimozide interfered with context-specific sensitization, whenever it was given. It is concluded that pimozide interferes with the expression of context-specific sensitization, although a separate effect on the development of sensitization is not ruled out.

Animals↗
PubMed1990

Differential modulation of mouse brain biogenic amines by haloperidol and pimozide: implications in Tourette's syndrome.

1. A comparison between the effect of equal dose regimens of Tourette's medications on mouse motor activity and regional brain monoamines suggests differential responses which may underlie drug-induced side-effects. 2. Haloperidol was more potent than pimozide in altering striatal dopamine concentration which may account for the greater incidence of haloperidol-induced extrapyramidal disorders compared to pimozide. 3. Pimozide, but not the haloperidol treatment, altered brain serotonin concentrations to suggest a decrease in turnover rate which may underlie pimozide-caused sedation in Tourette's syndrome. 4. Pimozide was more potent than haloperidol in duration of behavioral depression which suggests differential dopamine receptor subtypes blockade. 5. Pimozide was more potent than haloperidol in altering 3 of the 6 brain regions content of norepinephrine-derived normetanephrine which may be responsible for the increase in blood pressure reported during pimozide treatment.

Animals↗
PubMed2002

In vitro inhibition of pimozide N-dealkylation by selective serotonin reuptake inhibitors and azithromycin.

Pimozide is often coprescribed with serotonin reuptake inhibitor (SSRI) antidepressants to treat depression in patients with Tourette's syndrome. In human liver microsomes (HLMs), the inhibition of the primary route of pimozide metabolism, N-dealkylation to 1,3-dihydro-1-(4-piperidinyl)-2H-benzimidazol-2-one (DHPBI), by four SSRIs (fluoxetine, sertraline, paroxetine, and fluvoxamine) and azithromycin was tested. Inhibition constants (K(i) values) were estimated from Dixon plots (three HLMs for each inhibitor) using the appropriate enzyme inhibition model by nonlinear regression. At 10 microM paroxetine, sertraline, fluoxetine, or fluvoxamine, the formation of DHPBI from pimozide (10 microM) in HLMs was inhibited by an average (three HLMs) of 7%, 7.7%, 8%, and 16%, respectively, whereas this inhibition did not exceed 55% at the maximum concentrations (100 microM) of the SSRIs tested. Azithromycin had negligible effect on pimozide (10 microM) N-dealkylation (19% at 100 microM azithromycin). These inhibition data were compared with ketoconazole, which was included as a positive control of CYP3A inhibition. At 0.1 microM and 0.5 microM ketoconazole, the formation of DHPBI from 10 microM pimozide was inhibited by 32% and 62%, respectively. The K(i) values (+/- SD) of ketoconazole, sertraline, fluvoxamine, azithromycin, fluoxetine, and paroxetine were 0.07 microM, 89 +/- 44 microM, 89 +/- 24 microM, 103 +/- 52 microM, 117 +/- 27 microM, and 129 +/- 33 microM, respectively. These values are least 100-fold higher than the expected plasma concentrations after the usual daily doses of the SSRIs and azithromycin, suggesting that coadministration of SSRIs and azithromycin are unlikely to markedly diminish the elimination of pimozide in patients. However, in vivo predictions from in vitro data are not always perfect. In vivo, the SSRIs or azithromycin may concentrate in the liver relative to plasma. In addition, the possibility that these drugs could alter pimozide disposition through effects on transport proteins or via promoter repression cannot be ruled out.

Aryl Hydrocarbon Hydroxylases↗
PubMed1992

Effects of cocaine and pimozide on plasma and brain alpha-melanocyte-stimulating hormone levels in rats.

The effects of cocaine on rat plasma and brain alpha-melanocyte-stimulating hormone (alpha-MSH) levels have been studied by means of a specific radioimmunoassay. The selected brain areas were the hypothalamus, septum-nucleus accumbens and hippocampus. Cocaine given subcutaneously decreased the alpha-MSH levels in the peripheral blood. Pimozide, a dopaminergic antagonist, had an opposite effect: it increased the alpha-MSH levels in the peripheral blood. Combined treatment with cocaine + pimozide resulted in a decrease in the pimozide-induced increase in alpha-MSH levels in the blood. Cocaine and pimozide or the combination of cocaine + pimozide were ineffective on the alpha-MSH levels in the hypothalamus and septum-accumbens brain regions. In the hippocampus, cocaine in the dose applied induced a slight but not significant decrease in the alpha-MSH level. Pimozide caused a significant decrease in the hippocampal alpha-MSH level which disappeared at 60 min. Cocaine prevented the pimozide-induced depletion of alpha-MSH. The data indicate that cocaine may act as a dopaminergic agonist in the mechanism of control of alpha-MSH secretion from the intermediate lobe of the pituitary. The alpha-MSH levels in the brain are controlled by different mechanisms. In some brain areas, the dopaminergic system has no action; in others the mechanisms might be similar to but slightly different from that in the pituitary.

Animals↗
PubMed1997

Relative efficacy of haloperidol and pimozide in children and adolescents with Tourette's disorder.

OBJECTIVE: The authors evaluated the relative efficacy and safety of pimozide and haloperidol in the treatment of Gilles de la Tourette's syndrome in children and adolescents. METHOD: A double-blind, 24-week, placebo-controlled double crossover study of equivalent dose formulations of haloperidol and pimozide was conducted with 22 subjects, aged 7-16 years, with Tourette's disorder who were randomly assigned to first one active drug treatment and then the other. Biweekly assessment and flexible dose titration mimicked clinical practice. The primary outcome variable was total score on the Tourette Syndrome Global Scale. Final outcome was determined after 6 weeks of each treatment (placebo, pimozide, haloperidol), with a 2-week placebo baseline period and intervening 2-week placebo washout periods between treatments. RESULTS: Pimozide proved significantly different from placebo in affecting the primary outcome variable, whereas haloperidol failed to have a significant effect. Haloperidol exhibited a threefold higher frequency of serious side effects and significantly greater extrapyramidal symptoms relative to pimozide. Haloperidol-associated treatment-limiting adverse events were experienced by 41% of the patients. The therapeutic doses of pimozide and haloperidol were equivalent (mean = 3.4 mg/day, SD = 1.6, and mean = 3.5 mg/day, SD = 2.2, respectively). CONCLUSIONS: At equivalent doses, pimozide is superior to haloperidol for controlling symptoms of Tourette's disorder in children and adolescents.

Adolescent↗
PubMed2001

Pimozide (Orap) prolongs cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current in native cardiac myocytes.

BACKGROUND: Several cases of QT prolongation and ventricular tachyarrhythmia have been reported with pimozide, a potent neuroleptic useful in the management of motor and phonic tics associated with Tourette syndrome. To further elucidate the mechanism underlying these clinical observations, the effects of pimozide on monophasic action potential duration (MAPD(90)) and on potassium currents involved in the repolarization of native isolated ventricular myocytes were examined. METHODS AND RESULTS: Studies were undertaken in eight isolated guinea pig hearts that demonstrated reverse rate-dependent prolongation of cardiac repolarization by pimozide 100 nmol/L. Action potential duration increased 24% from baseline 115 +/- 2 to 142 +/- 4 msec with pimozide 100 nmol/L during pacing at 250 msec cycle length, while a 10% increase from 97 +/- 2 to 107 +/- 3 msec was seen with pacing at a cycle length of 150 msec. Experiments in native isolated ventricular myocytes (n = 20) demonstrated concentration-dependent block of the rapid component (I(Kr)) of the delayed rectifier potassium current: tail current was decreased by 50% at 15 nmol/L. CONCLUSIONS: Pimozide possesses cardiac electrophysiological effects similar to those of class III antiarrhythmic drugs. These effects are concentration-dependent and observed at recommended dosages of the drug. Since pimozide is strongly metabolized by CYP3A4, special care should be taken to avoid potential pharmacokinetic interactions leading to high plasma levels of pimozide and proarrhythmia.

Action Potentials↗
PubMed1995

Effect of pimozide on the increase of muscarinic receptors caused by mazindol and apomorphine in the rat cerebral motor cortex.

The effects of pimozide, mazindol and apomorphine on muscarinic receptors in homogenates of rat cerebral motor cortex were measured by binding assays, using 3H-N-methylscopolamine (3H-NMS) alone as ligand (for the measurement of M1- and M2-like receptors) or in the presence of carbachol or pirenzepine for determination of M1- and M2-like receptors, respectively. Female Wistar rats (150 g) were treated daily for one week with pimozide, a dopaminergic antagonist (10 and 20 mg/kg, po, by gavage), or with apomorphine (1 mg/kg, ip). In another set of experiments, animals were treated with pimozide and 30 min later with mazindol (10 mg/kg, po, by gavage) or apomorphine. The drugs were administered daily for one week. Controls received the same volume of saline. 3H-NMS binding was increased from the control value of 418 +/- 17 to 548 +/- 42 fmol/mg protein by administration of mazindol (10 mg/kg) but binding was reduced to 360 +/- 11 fmol/mg protein upon administration of pimozide (20 mg/kg) plus mazindol (10 mg/kg). Similarly 10 mg/kg pimozide reduced the increase in M1-like receptors caused by mazindol from 262 +/- 31 to 220 +/- 20 fmol/mg protein. Although 20 mg/kg pimozide alone produced a decrease in M1- plus M2-like receptors (from 418 +/- 17 to 348 +/- 22 fmol/mg protein), its action was preferentially on M2-like receptors, decreasing them from 148 +/- 10 to 111 +/- 15 fmol/mg protein in the control and treated groups, respectively. At the higher dose, 20 mg/kg pimozide also inhibited the 3H-NMS binding (M1- plus M2-like receptors) in the presence of apomorphine (263 +/- 25 vs 418 +/- 17 fmol/mg protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Pimozide therapy for trigeminal neuralgia.

Pimozide was compared with carbamazepine in a double-blind crossover trial in 48 patients with trigeminal neuralgia who were refractory to medical therapy. Pimozide treatment produced greater reduction in trigeminal neuralgia symptoms than carbamazepine treatment. All of the pimozide-treated patients improved, while only 56% of carbamazepine-treated patients were relieved of their pain. Although both drugs provoked some adverse effects, it was not necessary to interrupt the trial in any case. After this 24-week trial, all patients began receiving pimozide and were followed up according to an open-label study design. In all cases, the pimozide dosage was progressively reduced until the minimal effective dose was reached. Central and peripheral mechanisms that may underlie pimozide-induced improvement are discussed.

Carbamazepine↗
PubMed1982

Antipsychotic effects of pimozide in schizophrenia. Treatment response prediction with acute dextroamphetamine response.

Acute behavioral response to 20 mg of dextroamphetamine (intravenous) predicted fourth-week antipsychotic response to double-blind pimozide treatment. Patients whose psychotic condition improved with dextroamphetamine administration showed more antipsychotic response to pimozide therapy than those whose condition worsened or did not change. Multiple regression analysis indicated amphetamine-induced response predicted pimozide response after four weeks for fifth-week pimozide response was more accurately predicted by prepimozide psychosis ratings. Our study provides some evidence that mechanisms underlying early and late pimozide response are not necessarily identical. Because patients who did not respond to dextroamphetamine administration still improved with pimozide therapy, our data do not support the concept that schizophrenia can be divided into two groups (dopamine-sensitive or dopamine-insensitive) but, rather, that dopamine responsiveness changes over time. Clinical application is not warranted until studies with larger samples have replicated our findings.

Adolescent↗
PubMed1989

Controlled study of haloperidol, pimozide and placebo for the treatment of Gilles de la Tourette's syndrome.

The results of this controlled study of the treatment of 57 patients with Gilles de la Tourette's syndrome suggested that both haloperidol and pimozide were more effective than placebo, but that haloperidol was slightly more effective than pimozide. Adverse effects occurred more frequently with haloperidol vs placebo than with pimozide vs placebo, but the frequency was not significantly different for haloperidol compared with pimozide. Clinically significant cardiac effects did not occur at a maximum dosage of 0.3 mg/kg or 20 mg/d for pimozide and 10 mg/d for haloperidol. However, the QTc interval was prolonged during pimozide treatment compared with that during haloperidol treatment, although the values for both medications were not in an abnormal range.

Adolescent↗
PubMed1987

Pharmacokinetics of pimozide in adults and children with Tourette's syndrome.

Pimozide is a neuroleptic drug with dopamine receptor and calcium channel blocking activity that is used in the treatment of Tourette's syndrome. A comparison of the pharmacokinetics of pimozide was made in children and adults with Tourette's syndrome. Seven adults (ages 23-39) and four children (ages 6-13) received a single 2-mg oral dose of pimozide and a minimum of nine blood samples were collected over a four-day period. Mean elimination half-life of pimozide in children was 66 hours compared with 111 hours in adults with Tourette's syndrome. Significant interindividual variability of pimozide pharmacokinetics was found in both adults and children with Tourette's syndrome. The pharmacokinetics of pimozide in patients with Tourette's syndrome differs from that reported in adult populations with chronic schizophrenia.

Administration, Oral↗
PubMed1983

Failure of pimozide to disrupt the acquisition of light-dark and spatial discrimination problems.

The effects of pimozide, a dopamine (DA) receptor blocker, on associative learning was examined using two appetitively motivated choice paradigms. In Experiment I, low to moderate doses of pimozide (0.125, 0.25 mg/kg) were not found to disrupt the acquisition of a two bar simultaneous discrimination task. However, with continued testing, progressive deficits in response accuracy were observed in rats pretreated with 0.25 mg/kg pimozide. When subsequently tested drug-free these animals demonstrated a rapid and marked improvement in performance. Experiment II used a spatial discrimination task (T-maze) requiring a natural response (running) with minimal response demands (short stem and arms). Rats pretreated with 0.25, 0.50, and 1.0 mg/kg pimozide showed comparable levels of acquisition and maintained discriminated performance relative to vehicle controls. Similar results were obtained when the reinforced (S+) and nonreinforced (S-) stimuli were reversed. Moreover, animals receiving 2.0 mg/kg pimozide and not rendered cataleptic also demonstrated acquisition of both the initial discrimination and its reversal. It was concluded that rats pretreated with pimozide are able to acquire the significance of environmental stimuli and direct their responding accordingly if they are motorically capable of emitting the required response.

Animals↗
PubMed1982

Pimozide in the treatment of newly admitted schizophrenic patients.

Pimozide, a specific dopamine blocking agent, was compared with chlorpromazine in a 4-week double-blind study of the treatment of 40 schizophrenic patients newly admitted to hospital through the emergency room. Dosage was adjusted according to therapeutic effect and during the final week ranged from 10--70 mg/day (median 30 mg/day) for pimozide and 600--1,500 mg/day (median 900 mg/day) for chlorpromazine. Pimozide was found to exert somewhat less of an overall therapeutic effect than chlorpromazine, particularly in highly agitated patients. Women responded better to either treatment than men. A weighted mean of the doses given to male and female patients during the final week suggests that in the treatment of acutely ill patients the mg dose equivalency of pimozide in terms of chlorpromazine is approximately 1:25, considerably lower than estimates from maintenance studies. Pimozide induced significantly more parkinsonian symptoms but less autonomic side effects than chlorpromazine. It is suggested that the weaker presynaptic dopamine blocking effect of pimozide might be responsible for its reduced potency in the treatment of acute schizophrenic symptoms.

Acute Disease↗