Orap (pimozide) is a potent antipsychotic medication used to treat Tourette's syndrome, schizophrenia, chronic psychosis, and similar disorders. Some research suggests it may have benefits in treating autism as well. It is typically used when patients do not respond to other treatments or those other treatments cannot be used for some reason, such as allergies.

Orap is not considered suitable for children under 12 years of age, as there is no data backing up safety. It can be used in all other ages; however, this is a potent medication with potentially severe complications if misused. Guidance of a doctor is strongly recommended for the duration of Orap use.

What to Expect from Orap

Orap is beneficial in treating Tourette's syndrome, as it will help reduce the frequency and severity of motor tics and vocal tics. It is also beneficial in treating psychosis and delusional disorder, reducing or eliminating delusions, or at least allowing the patient be aware that it is a delusion. Orap has also been shown to be beneficial in treating paranoid personality disorder and alleviate or completely eliminate delusional parasitosis (a condition in which the patient believes they are infested with bugs but no infestation actually exists).

The medication accomplishes the above by acting on the central nervous system, decreasing the activity of dopamine in the brain among other actions. This is a powerful medication that, while it often works well, carries risk of an assortment of severe side effects. For this reason it is typically not the preferred medication in the majority of cases; use is reserved for when other medications are unsuitable or unavailable. See the Adverse Effects section below for more information about side effects.

Treatment should always start with low doses, gradually increased if needed. The ideal dosage is often a balance between suppression of symptoms and undesirable side effects. Treatment should periodically be reduced or stopped to see if the condition persists, though cessation of treatment will often produce a temporary worsening of symptoms.

This is a complicated medication used to treat complicated conditions and it is not advisable to attempt treatment without the guidance of a doctor.

Dosage & Administration

Orap comes in tablets, typically taken once per day at bedtime. Food is optional.

In children age 12 and up standard dosage is:

• Start with 0.5 mg Orap per kg of body weight per day.
• Dosage may be increased, if needed, every third day up to 0.2 mg Orap per kg of body weight per day.
• Do not exceed 0.2 mg per kg of body weight or 10 mg per day, whichever is lower.

In adults:

• Start with 1 or 2 mg Orap per day. This dose may be divided into two smaller doses taken morning and evening if a doctor advises.
• Dosage may be increased, if needed, every other day up to 0.2 mg Orap per kg of body weight.
• Do not exceed 0.2 mg per kg of body weight or 10 mg per day, whichever is lower.

Doctor instructions may vary and should always be followed.

Children taking more than 0.5 mg per day and adults taking more than 4 mg per day may be advised to have CYP 2D6 genotyping done. Patients who are poor CYP 2D6 metabolizers should not exceed 0.5 or 4 mg per day.

Some improvements are typically seen within days of reaching an effective dose. If there is no noticeable improvement after several days or the condition worsens at any time speak with a doctor.

Adverse Effects

As mentioned above this is a powerful medication that can produce serious adverse reactions. Patients should avoid Orap use altogether if there is a history---including family history---of:

• QT interval prolongation
• Heart arrhythmia
• Hypokalaemia (low blood potassium)
• Hypomagnesaemia (low blood magnesium)

Orap should also be avoided if taking certain medications:

• Selective serotonin reuptake inhibitors (SSRIs)
• CYP3A4, CYP1A2, or CYP2D6 inhibitors

Patients for whom the above do not apply may be administered Orap. Many patients will experience at least one side effect, though fortunately not all are dangerous. Common side effects include:

• Dry mouth
• Dizziness
• Constipation
• Excessive sleepiness
• Increased nighttime urination
• Excessive sweating
• Difficulty speaking

The above often stop occurring as the body adjusts to treatment. If they do not---or if they become severe enough to be disruptive---a doctor should be consulted; treatment may end, at which point side effects should reverse.

Major side effects are more rare but also more dangerous. These are dose-dependent to some degree; they're more likely to occur at higher doses, though there are exceptions. Side effects which warrant medical attention include:

• Low blood pressure
• Decreased number of blood cells
• QT interval prolongation
• Heart arrhythmia
• Severe sedation
• Extrapyramidal symptoms (involuntary body movements)

Some of the above can be difficult to detect without the aid of a doctor; regular checkups are highly advisable for this reason. Untreated the above can lead to a significant loss of quality of life, and some may lead to death. Stopping treatment usually reverses symptoms.

While the medications listed above should be avoided entirely while taking Orap, there are numerous others that can interact in somewhat less-severe ways. Always double-check with a doctor before taking other medications with Orap, including over-the-counter varieties.

Grapefruit and grapefruit juice should be avoided during treatment with Orap. Alcohol and recreational drugs are not advisable.