pimozide (Rx)

Tourette Disorder

Initial 1-2 mg PO qDay ; increase every other day; not to exceed 10 mg/day

Maintenance: <0.2 mg/kg/day or 10 mg/day, choose lowest dose  

Tourette Disorder

< 2 years

• Safety & efficacy not established

2-12 years

• Initial: 0.05 mg/kg/day PO qHS  
• Can be increased q3Days to 0.2 mg/kg/day PO qHS
• Maintenance dose: 2-4 mg/day; not to exceed 10 mg/day

>12 years

• Initial 1-2 mg PO qDay ; increase every other day; not to exceed 10 mg/day
• Maintenance: <0.2 mg/kg/day or 10 mg/day, choose lowest dose

Contraindicated (95)

• amiodarone

  amiodarone and pimozide both increase QTc interval. Contraindicated.

• amisulpride

  amisulpride and pimozide both increase QTc interval. Contraindicated.
  
  amisulpride, pimozide. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.

• amitriptyline

  amitriptyline and pimozide both increase QTc interval. Contraindicated.

• amoxapine

  amoxapine and pimozide both increase QTc interval. Contraindicated.

• aprepitant

  aprepitant increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• arsenic trioxide

  arsenic trioxide and pimozide both increase QTc interval. Contraindicated.

• artemether/lumefantrine

  artemether/lumefantrine and pimozide both increase QTc interval. Contraindicated.

• atazanavir

  atazanavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Risk of QT interval prolongation.

• azithromycin

  azithromycin increases toxicity of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.

• bupropion

  bupropion will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Both bupropion and hydroxybupropion (major metabolite) are considered strong CYP2D6 inhibitors; additionally, bupropion and pimozide lower seizure threshold

• chlorpromazine

  chlorpromazine and pimozide both increase QTc interval. Contraindicated.

• cimetidine

  cimetidine increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• citalopram

  citalopram and pimozide both increase QTc interval. Contraindicated.

• clarithromycin

  clarithromycin and pimozide both increase QTc interval. Contraindicated.
  
  clarithromycin increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• clomipramine

  clomipramine and pimozide both increase QTc interval. Contraindicated.

• cobicistat

  cobicistat will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Potential for increased systemic exposure of pimozide resulting in increased risk for QT prolongation
  
  cobicistat will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased systemic exposure of pimozide resulting in increased risk for QT prolongation.

• conivaptan

  conivaptan increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• crizotinib

  crizotinib and pimozide both increase QTc interval. Contraindicated. Pimozide is contraindicated with drugs that may prolong the QT interval. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.

• cyclosporine

  cyclosporine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• darunavir

  darunavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration with phenytoin may result in loss of therapeutic effect and development of resistance to darunavir.

• dasatinib

  dasatinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• desipramine

  desipramine and pimozide both increase QTc interval. Contraindicated.

• diltiazem

  diltiazem will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration with potent CYP3A4 inhibitors may significantly increase the plasma concentrations of pimozide and may potentiate the risk of ventricular arrhythmias (eg, ventricular tachycardia, torsade de pointes, cardiac arrest, sudden death).

• disopyramide

  disopyramide and pimozide both increase QTc interval. Contraindicated.

• dofetilide

  dofetilide and pimozide both increase QTc interval. Contraindicated.

• doxepin

  doxepin and pimozide both increase QTc interval. Contraindicated.

• dronedarone

  dronedarone and pimozide both increase QTc interval. Contraindicated.
  
  dronedarone increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• droperidol

  droperidol and pimozide both increase QTc interval. Contraindicated.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• epinephrine

  epinephrine and pimozide both increase QTc interval. Contraindicated.

• epinephrine racemic

  epinephrine racemic and pimozide both increase QTc interval. Contraindicated.

• erythromycin base

  erythromycin base and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin base increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin ethylsuccinate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• erythromycin lactobionate

  erythromycin lactobionate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin lactobionate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• erythromycin stearate

  erythromycin stearate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin stearate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• escitalopram

  escitalopram and pimozide both increase QTc interval. Contraindicated.

• fluconazole

  fluconazole and pimozide both increase QTc interval. Contraindicated.
  
  fluconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• fluoxetine

  fluoxetine and pimozide both increase QTc interval. Contraindicated.
  
  fluoxetine increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• fluphenazine

  fluphenazine and pimozide both increase QTc interval. Contraindicated.

• fosamprenavir

  fosamprenavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• fosaprepitant

  fosaprepitant increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• goserelin

  goserelin increases toxicity of pimozide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• haloperidol

  haloperidol and pimozide both increase QTc interval. Contraindicated.

• ibutilide

  ibutilide and pimozide both increase QTc interval. Contraindicated.

• imipramine

  imipramine and pimozide both increase QTc interval. Contraindicated.

• indapamide

  indapamide and pimozide both increase QTc interval. Contraindicated.

• itraconazole

  itraconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Both drugs will increase QT interval. Coadministration of pimozide and itraconazole is contraindicated during and 2 weeks after itraconazole treatment.

• ketoconazole

  ketoconazole and pimozide both increase QTc interval. Contraindicated.
  
  ketoconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• lapatinib

  lapatinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• lefamulin

  lefamulin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• letermovir

  letermovir increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of letermovir and pimozide is contraindicated due to risk of QT prolongations and torsades de pointes.

• leuprolide

  leuprolide increases toxicity of pimozide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• levoketoconazole

  levoketoconazole and pimozide both increase QTc interval. Contraindicated.
  
  levoketoconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• lofepramine

  lofepramine and pimozide both increase QTc interval. Contraindicated.

• lumefantrine

  lumefantrine and pimozide both increase QTc interval. Contraindicated.

• maprotiline

  maprotiline and pimozide both increase QTc interval. Contraindicated.

• marijuana

  marijuana increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• miconazole vaginal

  miconazole vaginal increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• mifepristone

  mifepristone increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index; combination may prolong QT interval .

• moxifloxacin

  moxifloxacin and pimozide both increase QTc interval. Contraindicated.

• nefazodone

  nefazodone increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• nelfinavir

  nelfinavir increases levels of pimozide by decreasing metabolism. Contraindicated. Potential for serious and/or life-threatening reactions (eg, cardiac arrhythmias).

• nilotinib

  nilotinib and pimozide both increase QTc interval. Contraindicated.
  
  nilotinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• nirmatrelvir

  nirmatrelvir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• nortriptyline

  nortriptyline and pimozide both increase QTc interval. Contraindicated.

• octreotide

  octreotide and pimozide both increase QTc interval. Contraindicated.

• octreotide (Antidote)

  octreotide (Antidote) and pimozide both increase QTc interval. Contraindicated.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for cardiac arrhythmias

• oxaliplatin

  oxaliplatin will increase the level or effect of pimozide by Other (see comment). Contraindicated. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• paroxetine

  paroxetine increases levels of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Contraindicated. Coadministration increases pimozide AUC and Cmax and may result in prolonged QT interval.

• pasireotide

  pimozide and pasireotide both increase QTc interval. Contraindicated.

• pentamidine

  pentamidine and pimozide both increase QTc interval. Contraindicated.

• perphenazine

  perphenazine and pimozide both increase QTc interval. Contraindicated.

• procainamide

  pimozide and procainamide both increase QTc interval. Contraindicated.

• prochlorperazine

  prochlorperazine and pimozide both increase QTc interval. Contraindicated.

• promazine

  promazine and pimozide both increase QTc interval. Contraindicated.

• promethazine

  promethazine and pimozide both increase QTc interval. Contraindicated.

• protriptyline

  protriptyline and pimozide both increase QTc interval. Contraindicated.

• quinidine

  quinidine and pimozide both increase QTc interval. Contraindicated.

• quinine

  pimozide and quinine both increase QTc interval. Contraindicated.

• ritonavir

  ritonavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• rolapitant

  rolapitant will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Rolapitant moderately inhibits CYP2D6. Coadministration with pimozide, a CYP2D6 substrate, causes a significant increase in pimozide plasma concentration that may result in QT prolongation and torsades de pointes.

• sertraline

  sertraline increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.

• sorafenib

  sorafenib and pimozide both increase QTc interval. Contraindicated.

• sotalol

  pimozide and sotalol both increase QTc interval. Contraindicated.

• thioridazine

  thioridazine and pimozide both increase QTc interval. Contraindicated.

• tipranavir

  tipranavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• toremifene

  pimozide and toremifene both increase QTc interval. Contraindicated. Concurrent use of pimozide with other agents that prolong QTc interval is contraindicated.

• trazodone

  trazodone and pimozide both increase QTc interval. Contraindicated.

• trifluoperazine

  trifluoperazine and pimozide both increase QTc interval. Contraindicated.

• trimipramine

  trimipramine and pimozide both increase QTc interval. Contraindicated.

• verapamil

  verapamil increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• voriconazole

  voriconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  voriconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• ziprasidone

  pimozide and ziprasidone both increase QTc interval. Contraindicated.

Serious - Use Alternative (151)

• abametapir

  abametapir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
  
  abametapir will increase the level or effect of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

• adagrasib

  adagrasib will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP2D6 inhibitor, with sensitive CYP2D6 substrates unless otherwise recommended in the prescribing information for these substrates.
  
  adagrasib, pimozide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  albuterol and pimozide both increase QTc interval. Contraindicated.

• alfuzosin

  alfuzosin and pimozide both increase QTc interval. Contraindicated.

• anagrelide

  anagrelide and pimozide both increase QTc interval. Contraindicated.

• apalutamide

  apalutamide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apomorphine

  pimozide decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
  
  apomorphine and pimozide both increase QTc interval. Contraindicated.

• aprepitant

  aprepitant will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Risk of QT interval prolongation.

• arformoterol

  arformoterol and pimozide both increase QTc interval. Contraindicated.

• aripiprazole

  aripiprazole and pimozide both increase QTc interval. Contraindicated.

• artemether

  artemether and pimozide both increase QTc interval. Contraindicated.

• asenapine

  asenapine and pimozide both increase QTc interval. Contraindicated.

• asenapine transdermal

  asenapine transdermal and pimozide both increase QTc interval. Contraindicated.

• atomoxetine

  atomoxetine and pimozide both increase QTc interval. Contraindicated.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• bremelanotide

  bremelanotide will decrease the level or effect of pimozide by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brigatinib

  brigatinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.

• bromocriptine

  pimozide decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• buprenorphine

  buprenorphine and pimozide both increase QTc interval. Contraindicated.

• buprenorphine buccal

  buprenorphine buccal and pimozide both increase QTc interval. Contraindicated.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and pimozide both increase QTc interval. Contraindicated.

• buprenorphine transdermal

  buprenorphine transdermal and pimozide both increase QTc interval. Contraindicated.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and pimozide both increase QTc interval. Contraindicated.

• cabergoline

  pimozide decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

• calcium/magnesium/potassium/sodium oxybates

  pimozide, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• ceritinib

  ceritinib and pimozide both increase QTc interval. Contraindicated.

• chloramphenicol

  chloramphenicol will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloroquine

  pimozide increases toxicity of chloroquine by QTc interval. Avoid or Use Alternate Drug.
  
  chloroquine increases toxicity of pimozide by QTc interval. Contraindicated.

• clozapine

  clozapine and pimozide both increase QTc interval. Contraindicated.

• dacomitinib

  dacomitinib will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• darifenacin

  darifenacin increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• dasatinib

  dasatinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• degarelix

  degarelix and pimozide both increase QTc interval. Contraindicated.

• DHEA, herbal

  DHEA, herbal increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• dolasetron

  dolasetron and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  donepezil and pimozide both increase QTc interval. Contraindicated.

• dopamine

  pimozide decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.

• efavirenz

  efavirenz and pimozide both increase QTc interval. Contraindicated.

• eliglustat

  eliglustat and pimozide both increase QTc interval. Contraindicated.

• encorafenib

  encorafenib and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• entrectinib

  pimozide and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  enzalutamide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• erdafitinib

  erdafitinib, pimozide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with erdafitinib and sensitive CYP3A4 substrates with narrow therapeutic indices. Erdafitinib may altered plasma concentrations of CYP3A4 substrates, leading to either loss of activity or increased toxicity of the substrate.

• eribulin

  eribulin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• famotidine

  famotidine, pimozide. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.
  
  pimozide, famotidine. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.

• fedratinib

  pimozide will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

• fentanyl

  fentanyl, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  fentanyl intranasal, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  fentanyl transdermal, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  fentanyl transmucosal, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fexinidazole

  fexinidazole and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  fingolimod and pimozide both increase QTc interval. Contraindicated.

• flecainide

  flecainide and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine increases toxicity of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  fluvoxamine and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• formoterol

  formoterol and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• fosaprepitant

  fosaprepitant will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Risk of QT interval prolongation.

• foscarnet

  foscarnet and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• gadobenate

  gadobenate and pimozide both increase QTc interval. Contraindicated.

• gemifloxacin

  gemifloxacin and pimozide both increase QTc interval. Contraindicated.

• gilteritinib

  gilteritinib and pimozide both increase QTc interval. Contraindicated.

• givosiran

  givosiran will increase the level or effect of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.
  
  givosiran will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glasdegib

  pimozide and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• granisetron

  granisetron and pimozide both increase QTc interval. Contraindicated.

• grapefruit

  grapefruit increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• histrelin

  histrelin increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hydrocodone

  hydrocodone, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  hydroxyzine and pimozide both increase QTc interval. Contraindicated.

• ibuprofen/famotidine

  ibuprofen/famotidine, pimozide. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.
  
  pimozide, ibuprofen/famotidine. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  iloperidone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• indinavir

  indinavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• inotuzumab

  inotuzumab and pimozide both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• isoflurane

  isoflurane and pimozide both increase QTc interval. Contraindicated.

• isoniazid

  isoniazid increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• ivosidenib

  ivosidenib and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• lapatinib

  lapatinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• lenacapavir

  lenacapavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• levodopa

  pimozide decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• levofloxacin

  levofloxacin and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• lidocaine

  lidocaine, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.

• lisuride

  pimozide decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.

• lithium

  lithium and pimozide both increase QTc interval. Contraindicated.

• lonafarnib

  pimozide will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• lopinavir

  lopinavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• lorlatinib

  lorlatinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.

• macimorelin

  macimorelin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• mefloquine

  mefloquine increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• methadone

  methadone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• methyldopa

  pimozide decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.

• metoclopramide intranasal

  pimozide, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
  
  pimozide increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

• metronidazole

  metronidazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• mexiletine

  mexiletine, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.

• mirtazapine

  mirtazapine and pimozide both increase QTc interval. Contraindicated.

• mobocertinib

  mobocertinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
  
  mobocertinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• nefazodone

  nefazodone will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nifedipine

  nifedipine increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• nizatidine

  nizatidine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ofloxacin

  ofloxacin and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  olanzapine and pimozide both increase QTc interval. Contraindicated.

• olopatadine intranasal

  pimozide and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• olutasidenib

  olutasidenib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.

• ondansetron

  pimozide and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oxaliplatin

  oxaliplatin and pimozide both increase QTc interval. Contraindicated.

• pacritinib

  pacritinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• paliperidone

  paliperidone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• panobinostat

  pimozide and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• pexidartinib

  pexidartinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.

• pimavanserin

  pimavanserin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

• pitolisant

  pimozide and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  pimozide and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
  
  posaconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• pramipexole

  pimozide decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.

• primaquine

  primaquine and pimozide both increase QTc interval. Contraindicated.

• propafenone

  propafenone, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.

• quinupristin/dalfopristin

  quinupristin/dalfopristin increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• ranolazine

  pimozide and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

• ribociclib

  ribociclib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.
  
  ribociclib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• risperidone

  pimozide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

• romidepsin

  pimozide and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

• ropinirole

  pimozide decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

• rucaparib

  rucaparib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• safinamide

  pimozide decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

• saquinavir

  saquinavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.
  
  saquinavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• selinexor

  selinexor, pimozide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• sertraline

  sertraline and pimozide both increase QTc interval. Contraindicated.

• sevoflurane

  sevoflurane and pimozide both increase QTc interval. Contraindicated.

• siponimod

  siponimod and pimozide both increase QTc interval. Contraindicated.

• sodium oxybate

  pimozide, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• solifenacin

  solifenacin and pimozide both increase QTc interval. Contraindicated.

• sotorasib

  sotorasib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications

• sufentanil SL

  sufentanil SL, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sulfamethoxazole

  sulfamethoxazole and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• sunitinib

  sunitinib and pimozide both increase QTc interval. Contraindicated.

• tacrolimus

  tacrolimus and pimozide both increase QTc interval. Contraindicated.

• telavancin

  pimozide and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

• tetrabenazine

  tetrabenazine and pimozide both increase QTc interval. Contraindicated.

• tipranavir

  tipranavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• trimethoprim

  pimozide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.

• triptorelin

  triptorelin increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• tropisetron

  pimozide and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.

• tucatinib

  tucatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  pimozide increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  pimozide, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• venlafaxine

  pimozide and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  pimozide increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• voriconazole

  pimozide and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  vorinostat and pimozide both increase QTc interval. Contraindicated.

• voxelotor

  voxelotor will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• zafirlukast

  zafirlukast increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• zileuton

  zileuton increases levels of pimozide by decreasing metabolism. Contraindicated. May prolong QTc interval.

Monitor Closely (336)

• abobotulinumtoxinA

  abobotulinumtoxinA increases effects of pimozide by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

• aclidinium

  aclidinium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• acrivastine

  acrivastine and pimozide both increase sedation. Use Caution/Monitor.

• albuterol

  pimozide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  alfentanil and pimozide both increase sedation. Use Caution/Monitor.

• alfuzosin

  pimozide and alfuzosin both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• alprazolam

  alprazolam and pimozide both increase sedation. Use Caution/Monitor.

• amifampridine

  pimozide increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amitriptyline

  pimozide and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and pimozide both increase sedation. Use Caution/Monitor.

• amoxapine

  pimozide and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.
  
  pimozide and amoxapine both increase sedation. Use Caution/Monitor.

• anticholinergic/sedative combos

  anticholinergic/sedative combos decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  anticholinergic/sedative combos decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• arformoterol

  pimozide increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aripiprazole

  aripiprazole and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  aripiprazole and pimozide both increase sedation. Use Caution/Monitor.

• armodafinil

  pimozide increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  asenapine and pimozide both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and pimozide both increase sedation. Use Caution/Monitor.

• atogepant

  pimozide will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atracurium

  atracurium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atracurium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine

  atropine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine IV/IM

  pimozide increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  atropine IV/IM decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine IV/IM decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

• avapritinib

  pimozide will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  avapritinib and pimozide both increase sedation. Use Caution/Monitor.

• axitinib

  pimozide increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azelastine

  azelastine and pimozide both increase sedation. Use Caution/Monitor.

• azithromycin

  azithromycin and pimozide both increase QTc interval. Modify Therapy/Monitor Closely.

• baclofen

  baclofen and pimozide both increase sedation. Use Caution/Monitor.

• bedaquiline

  pimozide and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  belladonna alkaloids decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna alkaloids decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• belladonna and opium

  belladonna and opium and pimozide both increase sedation. Use Caution/Monitor.
  
  belladonna and opium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna and opium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• benperidol

  benperidol and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  benperidol and pimozide both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen and pimozide both increase sedation. Use Caution/Monitor.

• benzphetamine

  pimozide increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benztropine

  pimozide increases effects of benztropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. .

• berotralstat

  berotralstat will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.

• brexanolone

  brexanolone, pimozide. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  brexpiprazole and pimozide both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and pimozide both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and pimozide both increase sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and pimozide both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and pimozide both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and pimozide both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and pimozide both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  pimozide increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• butabarbital

  butabarbital and pimozide both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and pimozide both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and pimozide both increase sedation. Use Caution/Monitor.

• caffeine

  pimozide increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cannabidiol

  cannabidiol, pimozide. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

• carbamazepine

  carbamazepine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and pimozide both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and pimozide both increase sedation. Use Caution/Monitor.

• cenobamate

  cenobamate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and pimozide both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and pimozide both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and pimozide both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  chlorpromazine and pimozide both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and pimozide both increase sedation. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine

  cinnarizine and pimozide both increase sedation. Use Caution/Monitor.

• ciprofloxacin

  ciprofloxacin and pimozide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

• cisatracurium

  cisatracurium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cisatracurium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• clarithromycin

  clarithromycin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clemastine

  clemastine and pimozide both increase sedation. Use Caution/Monitor.

• clobazam

  pimozide, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  pimozide and clomipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and pimozide both increase sedation. Use Caution/Monitor.

• clonidine

  clonidine, pimozide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• clorazepate

  clorazepate and pimozide both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  clozapine and pimozide both increase sedation. Use Caution/Monitor.

• codeine

  codeine and pimozide both increase sedation. Use Caution/Monitor.

• crofelemer

  crofelemer increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclizine

  cyclizine and pimozide both increase sedation. Use Caution/Monitor.
  
  cyclizine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclizine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• cyclobenzaprine

  cyclobenzaprine and pimozide both increase sedation. Use Caution/Monitor.
  
  cyclobenzaprine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclobenzaprine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• cyproheptadine

  cyproheptadine and pimozide both increase sedation. Use Caution/Monitor.

• dabrafenib

  dabrafenib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dantrolene

  dantrolene and pimozide both increase sedation. Use Caution/Monitor.

• daridorexant

  pimozide and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  darifenacin decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• deferasirox

  deferasirox will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  deferasirox increases levels of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• desflurane

  desflurane and pimozide both increase sedation. Use Caution/Monitor.

• desipramine

  pimozide and desipramine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  pimozide and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
  
  pimozide and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  pimozide and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  dexchlorpheniramine and pimozide both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  pimozide increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  dexmedetomidine and pimozide both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  pimozide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  pimozide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextromethorphan

  dextromethorphan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dextromoramide

  dextromoramide and pimozide both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and pimozide both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and pimozide both increase sedation. Use Caution/Monitor.

• dicyclomine

  dicyclomine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  dicyclomine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• diethylpropion

  pimozide increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and pimozide both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and pimozide both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  dihydroergotamine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dimenhydrinate

  dimenhydrinate and pimozide both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and pimozide both increase sedation. Use Caution/Monitor.
  
  diphenhydramine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  diphenhydramine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• diphenoxylate hcl

  diphenoxylate hcl and pimozide both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and pimozide both increase sedation. Use Caution/Monitor.

• dobutamine

  pimozide increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• donepezil transdermal

  donepezil transdermal, pimozide. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

• dopamine

  pimozide increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  pimozide increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  pimozide and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  pimozide and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and pimozide both increase sedation. Use Caution/Monitor.

• droperidol

  droperidol and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  droperidol and pimozide both increase sedation. Use Caution/Monitor.

• duvelisib

  duvelisib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• efavirenz

  efavirenz will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• elagolix

  elagolix decreases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  eletriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• eliglustat

  eliglustat increases levels of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• eluxadoline

  eluxadoline increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.

• ephedrine

  pimozide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  pimozide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  pimozide increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• erdafitinib

  erdafitinib, pimozide. Other (see comment). Modify Therapy/Monitor Closely. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.

• ergoloid mesylates

  ergoloid mesylates, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ergotamine

  ergotamine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• erythromycin base

  erythromycin base will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, pimozide. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  estazolam and pimozide both increase sedation. Use Caution/Monitor.

• ethanol

  pimozide and ethanol both increase sedation. Use Caution/Monitor.

• ezogabine

  ezogabine, pimozide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  pimozide increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  fentanyl, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ferric maltol

  ferric maltol, pimozide. Either increases effects of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• fesoterodine

  fesoterodine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  fesoterodine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• fexinidazole

  fexinidazole will increase the level or effect of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• finerenone

  pimozide will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

• flavoxate

  flavoxate decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  flavoxate decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• flibanserin

  pimozide will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
  
  flibanserin, pimozide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• fluphenazine

  fluphenazine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  fluphenazine and pimozide both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and pimozide both increase sedation. Use Caution/Monitor.

• formoterol

  pimozide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fostemsavir

  pimozide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  frovatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ganaxolone

  pimozide and ganaxolone both increase sedation. Use Caution/Monitor.

• gemtuzumab

  pimozide and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• glycerol phenylbutyrate

  glycerol phenylbutyrate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.

• glycopyrrolate

  pimozide increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• glycopyrrolate inhaled

  glycopyrrolate inhaled decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  glycopyrrolate inhaled decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• glycopyrronium tosylate topical

  glycopyrronium tosylate topical, pimozide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• guanfacine

  guanfacine, pimozide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• guselkumab

  guselkumab, pimozide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• haloperidol

  haloperidol and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  haloperidol and pimozide both increase sedation. Use Caution/Monitor.

• henbane

  henbane decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  henbane decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• homatropine

  homatropine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  homatropine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hydromorphone

  hydromorphone and pimozide both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and pimozide both increase sedation. Use Caution/Monitor.

• hyoscyamine

  hyoscyamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hyoscyamine spray

  pimozide increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  hyoscyamine spray decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine spray decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

• iloperidone

  iloperidone and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  iloperidone and pimozide both increase sedation. Use Caution/Monitor.
  
  iloperidone increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  imatinib increases levels of pimozide by decreasing metabolism. Use Caution/Monitor.

• imipramine

  pimozide and imipramine both increase sedation. Use Caution/Monitor.

• incobotulinumtoxinA

  pimozide increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• indacaterol, inhaled

  indacaterol, inhaled, pimozide. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• ipratropium

  ipratropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  ipratropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• isavuconazonium sulfate

  pimozide will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  isavuconazonium sulfate will increase the level or effect of pimozide by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.

• isoniazid

  isoniazid will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isoproterenol

  pimozide increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of pimozide by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• ketoconazole

  ketoconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketotifen, ophthalmic

  pimozide and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lasmiditan

  lasmiditan, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  pimozide will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
  
  lemborexant, pimozide. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenvatinib

  pimozide and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• levalbuterol

  pimozide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levoketoconazole

  levoketoconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levomilnacipran

  levomilnacipran, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• levorphanol

  levorphanol and pimozide both increase sedation. Use Caution/Monitor.

• linezolid

  linezolid, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lisdexamfetamine

  pimozide increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lithium

  lithium, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lofepramine

  pimozide and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  pimozide and lofexidine both increase sedation. Use Caution/Monitor.
  
  pimozide and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.

• lomitapide

  pimozide increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• loprazolam

  loprazolam and pimozide both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and pimozide both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lormetazepam

  lormetazepam and pimozide both increase sedation. Use Caution/Monitor.

• loxapine

  loxapine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine and pimozide both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine inhaled and pimozide both increase sedation. Use Caution/Monitor.

• lurasidone

  lurasidone, pimozide. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maprotiline

  pimozide and maprotiline both increase sedation. Use Caution/Monitor.

• marijuana

  pimozide and marijuana both increase sedation. Use Caution/Monitor.

• mavacamten

  pimozide will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.

• meclizine

  meclizine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  meclizine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• melatonin

  pimozide and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  meperidine and pimozide both increase sedation. Use Caution/Monitor.
  
  meperidine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• meprobamate

  pimozide and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  pimozide increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and pimozide both increase sedation. Use Caution/Monitor.

• methadone

  methadone and pimozide both increase sedation. Use Caution/Monitor.
  
  methadone, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• methamphetamine

  pimozide increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and pimozide both increase sedation. Use Caution/Monitor.

• methscopolamine

  methscopolamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  methscopolamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• methylenedioxymethamphetamine

  pimozide increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylergonovine

  methylergonovine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• methylphenidate

  pimozide increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• metoclopramide

  pimozide and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

• midazolam

  midazolam and pimozide both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  pimozide will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
  
  midazolam intranasal, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  pimozide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• milnacipran

  milnacipran, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• mirtazapine

  pimozide and mirtazapine both increase sedation. Use Caution/Monitor.

• mitotane

  mitotane decreases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• modafinil

  pimozide increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  morphine and pimozide both increase sedation. Use Caution/Monitor.

• motherwort

  pimozide and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  pimozide and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  pimozide and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  nalbuphine and pimozide both increase sedation. Use Caution/Monitor.

• naratriptan

  naratriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• norepinephrine

  pimozide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  pimozide and nortriptyline both increase sedation. Use Caution/Monitor.

• olanzapine

  olanzapine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  olanzapine and pimozide both increase sedation. Use Caution/Monitor.

• oliceridine

  oliceridine, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• olodaterol inhaled

  pimozide and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omaveloxolone

  omaveloxolone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.

• onabotulinumtoxinA

  onabotulinumtoxinA decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  onabotulinumtoxinA decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• opium tincture

  opium tincture and pimozide both increase sedation. Use Caution/Monitor.

• orphenadrine

  orphenadrine and pimozide both increase sedation. Use Caution/Monitor.

• osilodrostat

  osilodrostat and pimozide both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and pimozide both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxazepam

  oxazepam and pimozide both increase sedation. Use Caution/Monitor.

• oxybutynin

  oxybutynin decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin topical

  oxybutynin topical decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin topical decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin transdermal

  oxybutynin transdermal decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin transdermal decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxycodone

  oxycodone and pimozide both increase sedation. Use Caution/Monitor.

• oxymorphone

  oxymorphone and pimozide both increase sedation. Use Caution/Monitor.

• ozanimod

  ozanimod and pimozide both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• palbociclib

  palbociclib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib

• paliperidone

  paliperidone and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  paliperidone and pimozide both increase sedation. Use Caution/Monitor.

• pancuronium

  pancuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pancuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• panobinostat

  panobinostat will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.

• papaveretum

  papaveretum and pimozide both increase sedation. Use Caution/Monitor.

• papaverine

  pimozide and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  paroxetine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pazopanib

  pazopanib and pimozide both increase QTc interval. Modify Therapy/Monitor Closely.

• pentazocine

  pentazocine and pimozide both increase sedation. Use Caution/Monitor.

• pentobarbital

  pentobarbital and pimozide both increase sedation. Use Caution/Monitor.

• perphenazine

  perphenazine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  perphenazine and pimozide both increase sedation. Use Caution/Monitor.

• phendimetrazine

  pimozide increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenelzine

  phenelzine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• phenobarbital

  phenobarbital and pimozide both increase sedation. Use Caution/Monitor.

• phentermine

  pimozide increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  pimozide increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  pimozide increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• pholcodine

  pimozide and pholcodine both increase sedation. Use Caution/Monitor.

• pirbuterol

  pimozide increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pralidoxime

  pralidoxime decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pralidoxime decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• primidone

  primidone and pimozide both increase sedation. Use Caution/Monitor.

• procarbazine

  procarbazine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• prochlorperazine

  pimozide and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and prochlorperazine both increase sedation. Use Caution/Monitor.

• promethazine

  pimozide and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  promethazine and pimozide both increase sedation. Use Caution/Monitor.
  
  promethazine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• propantheline

  propantheline decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  propantheline decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• propofol

  propofol and pimozide both increase sedation. Use Caution/Monitor.

• propylhexedrine

  pimozide increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  pimozide and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  quazepam and pimozide both increase sedation. Use Caution/Monitor.

• quetiapine

  pimozide and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and quetiapine both increase sedation. Use Caution/Monitor.
  
  quetiapine, pimozide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• ramelteon

  pimozide and ramelteon both increase sedation. Use Caution/Monitor.

• rapacuronium

  rapacuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rapacuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• remimazolam

  remimazolam, pimozide. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• rifabutin

  rifabutin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of pimozide by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• rimabotulinumtoxinB

  pimozide, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

• risperidone

  pimozide and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and risperidone both increase sedation. Use Caution/Monitor.

• rizatriptan

  rizatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• rocuronium

  rocuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rocuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• ropeginterferon alfa 2b

  ropeginterferon alfa 2b will increase the level or effect of pimozide by Other (see comment). Use Caution/Monitor. Certain proinflammatory cytokines, including interferons, can suppress CYP450 enzymes resulting in increased exposures of some CYP substrates. Therefore, monitor patients who are receiving concomitant drugs that are CYP450 substrates with a narrow therapeutic index from toxicities to such drugs.

• salmeterol

  pimozide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• schisandra

  schisandra will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• scopolamine

  scopolamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  scopolamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• scullcap

  pimozide and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and pimozide both increase sedation. Use Caution/Monitor.

• selegiline

  selegiline, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• selpercatinib

  selpercatinib increases toxicity of pimozide by QTc interval. Use Caution/Monitor.

• shepherd's purse

  pimozide and shepherd's purse both increase sedation. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of pimozide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of pimozide by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of pimozide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of pimozide by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• solifenacin

  solifenacin decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  solifenacin decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• St John's Wort

  St John's Wort will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  stiripentol, pimozide. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.
  
  stiripentol, pimozide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  sufentanil and pimozide both increase sedation. Use Caution/Monitor.

• sumatriptan

  sumatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• sumatriptan intranasal

  sumatriptan intranasal, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• tapentadol

  tapentadol and pimozide both increase sedation. Use Caution/Monitor.

• tazemetostat

  tazemetostat will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  pimozide will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• teclistamab

  teclistamab will increase the level or effect of pimozide by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.

• tecovirimat

  tecovirimat will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• teduglutide

  teduglutide increases levels of pimozide by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

• telotristat ethyl

  telotristat ethyl will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.

• temazepam

  temazepam and pimozide both increase sedation. Use Caution/Monitor.

• terbinafine

  terbinafine will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  pimozide increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• teriflunomide

  teriflunomide decreases levels of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tetrabenazine

  pimozide and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

• thioridazine

  pimozide and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  pimozide and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and thiothixene both increase sedation. Use Caution/Monitor.

• tinidazole

  pimozide will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tiotropium

  tiotropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tiotropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• tolterodine

  tolterodine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tolterodine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• topiramate

  pimozide and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and pimozide both increase sedation. Use Caution/Monitor.

• tranylcypromine

  tranylcypromine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trazodone

  pimozide and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and pimozide both increase sedation. Use Caution/Monitor.

• triclabendazole

  triclabendazole and pimozide both increase QTc interval. Use Caution/Monitor.

• triclofos

  triclofos and pimozide both increase sedation. Use Caution/Monitor.

• trifluoperazine

  pimozide and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and trifluoperazine both increase sedation. Use Caution/Monitor.

• trihexyphenidyl

  pimozide increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimipramine

  pimozide and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and pimozide both increase sedation. Use Caution/Monitor.

• trofinetide

  trofinetide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).

• trospium chloride

  trospium chloride decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  trospium chloride decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• turmeric

  turmeric will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• valbenazine

  valbenazine and pimozide both increase QTc interval. Use Caution/Monitor.

• vecuronium

  vecuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  vecuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• venlafaxine

  venlafaxine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• vilazodone

  vilazodone, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• voclosporin

  voclosporin, pimozide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• xylometazoline

  pimozide increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  pimozide increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  pimozide and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  pimozide and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and ziprasidone both increase sedation. Use Caution/Monitor.

• zolmitriptan

  zolmitriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• zotepine

  pimozide and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and zotepine both increase sedation. Use Caution/Monitor.

Minor (61)

• acetazolamide

  acetazolamide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• amobarbital

  amobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anastrozole

  anastrozole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• armodafinil

  armodafinil will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• artemether/lumefantrine

  artemether/lumefantrine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bosentan

  bosentan will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• brimonidine

  brimonidine increases effects of pimozide by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• budesonide

  budesonide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butabarbital

  butabarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butalbital

  butalbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• chasteberry

  chasteberry decreases effects of pimozide by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).

• conivaptan

  conivaptan will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cortisone

  cortisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darifenacin

  darifenacin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dasatinib

  dasatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexamethasone

  dexamethasone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• DHEA, herbal

  DHEA, herbal will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dronedarone

  dronedarone will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ethanol

  ethanol, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• etravirine

  etravirine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus

  pimozide and eucalyptus both increase sedation. Minor/Significance Unknown.

• fluconazole

  fluconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosamprenavir

  fosamprenavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosphenytoin

  fosphenytoin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• grapefruit

  grapefruit will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• griseofulvin

  griseofulvin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lapatinib

  lapatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• larotrectinib

  larotrectinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lumefantrine

  lumefantrine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• marijuana

  marijuana will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• methylprednisolone

  methylprednisolone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metronidazole

  metronidazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miconazole vaginal

  miconazole vaginal will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nafcillin

  nafcillin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nelfinavir

  nelfinavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nevirapine

  nevirapine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  nifedipine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  nilotinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phenobarbital

  phenobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phenytoin

  phenytoin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• posaconazole

  posaconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• prednisone

  prednisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primidone

  primidone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rifapentine

  rifapentine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ritonavir

  ritonavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rufinamide

  rufinamide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib

  pimozide will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  pimozide will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage

  pimozide and sage both increase sedation. Minor/Significance Unknown.

• secobarbital

  secobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sulfamethoxazole

  sulfamethoxazole decreases levels of pimozide by unspecified interaction mechanism. Minor/Significance Unknown.

• topiramate

  topiramate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• verapamil

  verapamil will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• zafirlukast

  zafirlukast will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• abametapir

  Serious - Use Alternative (2)abametapir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
  
  abametapir will increase the level or effect of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

• abobotulinumtoxinA

  Monitor Closely (1)abobotulinumtoxinA increases effects of pimozide by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• aclidinium

  Monitor Closely (2)aclidinium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• acrivastine

  Monitor Closely (1)acrivastine and pimozide both increase sedation. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (2)adagrasib will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP2D6 inhibitor, with sensitive CYP2D6 substrates unless otherwise recommended in the prescribing information for these substrates.
  
  adagrasib, pimozide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  Monitor Closely (1)pimozide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)albuterol and pimozide both increase QTc interval. Contraindicated.

• alfentanil

  Monitor Closely (1)alfentanil and pimozide both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (1)pimozide and alfuzosin both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)alfuzosin and pimozide both increase QTc interval. Contraindicated.

• almotriptan

  Monitor Closely (1)almotriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• alprazolam

  Monitor Closely (1)alprazolam and pimozide both increase sedation. Use Caution/Monitor.

• amifampridine

  Monitor Closely (1)pimozide increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Contraindicated (1)amiodarone and pimozide both increase QTc interval. Contraindicated.

• amisulpride

  Contraindicated (2)amisulpride and pimozide both increase QTc interval. Contraindicated.
  
  amisulpride, pimozide. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.

• amitriptyline

  Contraindicated (1)amitriptyline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital

  Monitor Closely (1)amobarbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)amobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• amoxapine

  Contraindicated (1)amoxapine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)pimozide and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.
  
  pimozide and amoxapine both increase sedation. Use Caution/Monitor.

• anagrelide

  Serious - Use Alternative (1)anagrelide and pimozide both increase QTc interval. Contraindicated.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anticholinergic/sedative combos

  Monitor Closely (3)anticholinergic/sedative combos decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  anticholinergic/sedative combos decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• apalutamide

  Serious - Use Alternative (1)apalutamide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apomorphine

  Serious - Use Alternative (2)apomorphine and pimozide both increase QTc interval. Contraindicated.
  
  pimozide decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• aprepitant

  Contraindicated (1)aprepitant increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)aprepitant will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Risk of QT interval prolongation.

• arformoterol

  Monitor Closely (1)pimozide increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)arformoterol and pimozide both increase QTc interval. Contraindicated.

• aripiprazole

  Monitor Closely (2)aripiprazole and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  aripiprazole and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and pimozide both increase QTc interval. Contraindicated.

• armodafinil

  Monitor Closely (1)pimozide increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arsenic trioxide

  Contraindicated (1)arsenic trioxide and pimozide both increase QTc interval. Contraindicated.

• artemether

  Serious - Use Alternative (1)artemether and pimozide both increase QTc interval. Contraindicated.

• artemether/lumefantrine

  Contraindicated (1)artemether/lumefantrine and pimozide both increase QTc interval. Contraindicated.Minor (1)artemether/lumefantrine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• asenapine

  Monitor Closely (1)asenapine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine and pimozide both increase QTc interval. Contraindicated.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine transdermal and pimozide both increase QTc interval. Contraindicated.

• atazanavir

  Contraindicated (1)atazanavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Risk of QT interval prolongation.

• atogepant

  Monitor Closely (1)pimozide will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Serious - Use Alternative (1)atomoxetine and pimozide both increase QTc interval. Contraindicated.

• atracurium

  Monitor Closely (3)atracurium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atracurium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine

  Monitor Closely (3)atropine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine IV/IM

  Monitor Closely (3)pimozide increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  atropine IV/IM decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine IV/IM decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

• avapritinib

  Monitor Closely (2)pimozide will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  avapritinib and pimozide both increase sedation. Use Caution/Monitor.

• axitinib

  Monitor Closely (1)pimozide increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azelastine

  Monitor Closely (1)azelastine and pimozide both increase sedation. Use Caution/Monitor.

• azithromycin

  Contraindicated (1)azithromycin increases toxicity of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.Monitor Closely (1)azithromycin and pimozide both increase QTc interval. Modify Therapy/Monitor Closely.

• baclofen

  Monitor Closely (1)baclofen and pimozide both increase sedation. Use Caution/Monitor.

• bedaquiline

  Monitor Closely (1)pimozide and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  Monitor Closely (3)belladonna alkaloids decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna alkaloids decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• belladonna and opium

  Monitor Closely (4)belladonna and opium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna and opium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  belladonna and opium and pimozide both increase sedation. Use Caution/Monitor.

• benperidol

  Monitor Closely (2)benperidol and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  benperidol and pimozide both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)benzhydrocodone/acetaminophen, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• benzphetamine

  Monitor Closely (1)pimozide increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benztropine

  Monitor Closely (1)pimozide increases effects of benztropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. .

• berotralstat

  Monitor Closely (1)berotralstat will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.

• bosentan

  Minor (1)bosentan will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of pimozide by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexanolone

  Monitor Closely (1)brexanolone, pimozide. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  Monitor Closely (1)brexpiprazole and pimozide both increase sedation. Use Caution/Monitor.

• brigatinib

  Serious - Use Alternative (1)brigatinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.

• brimonidine

  Monitor Closely (1)brimonidine and pimozide both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of pimozide by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• brivaracetam

  Monitor Closely (1)brivaracetam and pimozide both increase sedation. Use Caution/Monitor.

• bromocriptine

  Serious - Use Alternative (1)pimozide decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• brompheniramine

  Monitor Closely (1)brompheniramine and pimozide both increase sedation. Use Caution/Monitor.

• budesonide

  Minor (1)budesonide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• buprenorphine

  Monitor Closely (1)buprenorphine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and pimozide both increase QTc interval. Contraindicated.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and pimozide both increase QTc interval. Contraindicated.

• buprenorphine subdermal implant

  Monitor Closely (1)buprenorphine subdermal implant and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine subdermal implant and pimozide both increase QTc interval. Contraindicated.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and pimozide both increase QTc interval. Contraindicated.

• buprenorphine, long-acting injection

  Monitor Closely (1)pimozide increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.Serious - Use Alternative (1)buprenorphine, long-acting injection and pimozide both increase QTc interval. Contraindicated.

• bupropion

  Contraindicated (1)bupropion will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Both bupropion and hydroxybupropion (major metabolite) are considered strong CYP2D6 inhibitors; additionally, bupropion and pimozide lower seizure threshold

• butabarbital

  Monitor Closely (1)butabarbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)butabarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butalbital

  Monitor Closely (1)butalbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)butalbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butorphanol

  Monitor Closely (1)butorphanol and pimozide both increase sedation. Use Caution/Monitor.

• cabergoline

  Serious - Use Alternative (1)pimozide decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

• caffeine

  Monitor Closely (1)pimozide increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)pimozide, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• cannabidiol

  Monitor Closely (1)cannabidiol, pimozide. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

• carbamazepine

  Monitor Closely (1)carbamazepine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and pimozide both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and pimozide both increase sedation. Use Caution/Monitor.

• cenobamate

  Monitor Closely (2)cenobamate, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• ceritinib

  Serious - Use Alternative (1)ceritinib and pimozide both increase QTc interval. Contraindicated.

• chasteberry

  Minor (1)chasteberry decreases effects of pimozide by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).

• chloral hydrate

  Monitor Closely (1)chloral hydrate and pimozide both increase sedation. Use Caution/Monitor.

• chloramphenicol

  Serious - Use Alternative (1)chloramphenicol will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and pimozide both increase sedation. Use Caution/Monitor.

• chloroquine

  Serious - Use Alternative (2)chloroquine increases toxicity of pimozide by QTc interval. Contraindicated.
  
  pimozide increases toxicity of chloroquine by QTc interval. Avoid or Use Alternate Drug.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and pimozide both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Contraindicated (1)chlorpromazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)chlorpromazine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  chlorpromazine and pimozide both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and pimozide both increase sedation. Use Caution/Monitor.

• cimetidine

  Contraindicated (1)cimetidine increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)cimetidine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine

  Monitor Closely (1)cinnarizine and pimozide both increase sedation. Use Caution/Monitor.

• ciprofloxacin

  Monitor Closely (1)ciprofloxacin and pimozide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

• cisatracurium

  Monitor Closely (3)cisatracurium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cisatracurium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• citalopram

  Contraindicated (1)citalopram and pimozide both increase QTc interval. Contraindicated.

• clarithromycin

  Contraindicated (2)clarithromycin and pimozide both increase QTc interval. Contraindicated.
  
  clarithromycin increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)clarithromycin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clemastine

  Monitor Closely (1)clemastine and pimozide both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (1)pimozide, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  Contraindicated (1)clomipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and clomipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  Monitor Closely (1)clonazepam and pimozide both increase sedation. Use Caution/Monitor.

• clonidine

  Monitor Closely (1)clonidine, pimozide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• clorazepate

  Monitor Closely (1)clorazepate and pimozide both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (2)clozapine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  clozapine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and pimozide both increase QTc interval. Contraindicated.

• cobicistat

  Contraindicated (2)cobicistat will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Potential for increased systemic exposure of pimozide resulting in increased risk for QT prolongation
  
  cobicistat will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased systemic exposure of pimozide resulting in increased risk for QT prolongation.

• codeine

  Monitor Closely (1)codeine and pimozide both increase sedation. Use Caution/Monitor.

• conivaptan

  Contraindicated (1)conivaptan increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)conivaptan will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cortisone

  Minor (1)cortisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• crizotinib

  Contraindicated (1)crizotinib and pimozide both increase QTc interval. Contraindicated. Pimozide is contraindicated with drugs that may prolong the QT interval. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.

• crofelemer

  Monitor Closely (1)crofelemer increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclizine

  Monitor Closely (4)cyclizine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclizine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  cyclizine and pimozide both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (4)cyclobenzaprine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclobenzaprine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  cyclobenzaprine and pimozide both increase sedation. Use Caution/Monitor.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclosporine

  Contraindicated (1)cyclosporine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and pimozide both increase sedation. Use Caution/Monitor.

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene

  Monitor Closely (1)dantrolene and pimozide both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)pimozide and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (3)darifenacin decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  darifenacin decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Serious - Use Alternative (1)darifenacin increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)darifenacin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darunavir

  Contraindicated (1)darunavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration with phenytoin may result in loss of therapeutic effect and development of resistance to darunavir.

• dasatinib

  Contraindicated (1)dasatinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)dasatinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)dasatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• deferasirox

  Monitor Closely (2)deferasirox will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  deferasirox increases levels of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• degarelix

  Serious - Use Alternative (1)degarelix and pimozide both increase QTc interval. Contraindicated.

• desflurane

  Monitor Closely (1)desflurane and pimozide both increase sedation. Use Caution/Monitor.

• desipramine

  Contraindicated (1)desipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and desipramine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  Monitor Closely (3)pimozide and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  pimozide and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
  
  pimozide and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.

• dexamethasone

  Minor (1)dexamethasone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and pimozide both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (1)pimozide increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and pimozide both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)pimozide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  Monitor Closely (1)pimozide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextromethorphan

  Monitor Closely (1)dextromethorphan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dextromoramide

  Monitor Closely (1)dextromoramide and pimozide both increase sedation. Use Caution/Monitor.

• DHEA, herbal

  Serious - Use Alternative (1)DHEA, herbal increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)DHEA, herbal will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• diamorphine

  Monitor Closely (1)diamorphine and pimozide both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and pimozide both increase sedation. Use Caution/Monitor.

• dicyclomine

  Monitor Closely (3)dicyclomine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  dicyclomine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• diethylpropion

  Monitor Closely (1)pimozide increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  Monitor Closely (1)difelikefalin and pimozide both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and pimozide both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  Monitor Closely (1)dihydroergotamine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• diltiazem

  Contraindicated (1)diltiazem will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration with potent CYP3A4 inhibitors may significantly increase the plasma concentrations of pimozide and may potentiate the risk of ventricular arrhythmias (eg, ventricular tachycardia, torsade de pointes, cardiac arrest, sudden death).

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and pimozide both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (4)diphenhydramine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  diphenhydramine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  diphenhydramine and pimozide both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and pimozide both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and pimozide both increase sedation. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)disopyramide and pimozide both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (1)pimozide increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dofetilide

  Contraindicated (1)dofetilide and pimozide both increase QTc interval. Contraindicated.

• dolasetron

  Serious - Use Alternative (1)dolasetron and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  Serious - Use Alternative (1)donepezil and pimozide both increase QTc interval. Contraindicated.

• donepezil transdermal

  Monitor Closely (1)donepezil transdermal, pimozide. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

• dopamine

  Monitor Closely (1)pimozide increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)pimozide decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.

• dopexamine

  Monitor Closely (1)pimozide increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  Monitor Closely (1)pimozide and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  Contraindicated (1)doxepin and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  Monitor Closely (1)doxylamine and pimozide both increase sedation. Use Caution/Monitor.

• dronedarone

  Contraindicated (2)dronedarone and pimozide both increase QTc interval. Contraindicated.
  
  dronedarone increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)dronedarone will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• droperidol

  Contraindicated (1)droperidol and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)droperidol and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  droperidol and pimozide both increase sedation. Use Caution/Monitor.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• efavirenz

  Monitor Closely (1)efavirenz will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)efavirenz and pimozide both increase QTc interval. Contraindicated.

• elagolix

  Monitor Closely (1)elagolix decreases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  Monitor Closely (1)eletriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• eliglustat

  Monitor Closely (1)eliglustat increases levels of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.Serious - Use Alternative (1)eliglustat and pimozide both increase QTc interval. Contraindicated.

• eluxadoline

  Monitor Closely (1)eluxadoline increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Contraindicated (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Serious - Use Alternative (1)encorafenib and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• entrectinib

  Serious - Use Alternative (1)pimozide and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  Serious - Use Alternative (1)enzalutamide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• ephedrine

  Monitor Closely (1)pimozide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Contraindicated (1)epinephrine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  Contraindicated (1)epinephrine racemic and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• erdafitinib

  Monitor Closely (1)erdafitinib, pimozide. Other (see comment). Modify Therapy/Monitor Closely. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.Serious - Use Alternative (1)erdafitinib, pimozide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with erdafitinib and sensitive CYP3A4 substrates with narrow therapeutic indices. Erdafitinib may altered plasma concentrations of CYP3A4 substrates, leading to either loss of activity or increased toxicity of the substrate.

• ergoloid mesylates

  Monitor Closely (1)ergoloid mesylates, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ergotamine

  Monitor Closely (1)ergotamine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• eribulin

  Serious - Use Alternative (1)eribulin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• erythromycin base

  Contraindicated (2)erythromycin base and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin base increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)erythromycin base will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin ethylsuccinate

  Contraindicated (2)erythromycin ethylsuccinate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin ethylsuccinate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin lactobionate

  Contraindicated (2)erythromycin lactobionate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin lactobionate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)erythromycin lactobionate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin stearate

  Contraindicated (2)erythromycin stearate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin stearate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)erythromycin stearate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• escitalopram

  Contraindicated (1)escitalopram and pimozide both increase QTc interval. Contraindicated.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, pimozide. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  Minor (1)eslicarbazepine acetate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• estazolam

  Monitor Closely (1)estazolam and pimozide both increase sedation. Use Caution/Monitor.

• ethanol

  Monitor Closely (1)pimozide and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• etravirine

  Minor (1)etravirine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus

  Minor (1)pimozide and eucalyptus both increase sedation. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine, pimozide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• famotidine

  Serious - Use Alternative (2)famotidine, pimozide. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.
  
  pimozide, famotidine. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.

• fedratinib

  Monitor Closely (2)fedratinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.Serious - Use Alternative (1)pimozide will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

• fenfluramine

  Monitor Closely (1)pimozide increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  Monitor Closely (1)fentanyl, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)fentanyl, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  Serious - Use Alternative (1)fentanyl intranasal, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  Serious - Use Alternative (1)fentanyl transdermal, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  Serious - Use Alternative (1)fentanyl transmucosal, pimozide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• ferric maltol

  Monitor Closely (1)ferric maltol, pimozide. Either increases effects of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• fesoterodine

  Monitor Closely (3)fesoterodine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  fesoterodine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• fexinidazole

  Monitor Closely (1)fexinidazole will increase the level or effect of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)fexinidazole and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• finerenone

  Monitor Closely (1)pimozide will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

• fingolimod

  Serious - Use Alternative (1)fingolimod and pimozide both increase QTc interval. Contraindicated.

• flavoxate

  Monitor Closely (3)flavoxate decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  flavoxate decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• flecainide

  Serious - Use Alternative (1)flecainide and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• flibanserin

  Monitor Closely (2)pimozide will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
  
  flibanserin, pimozide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• fluconazole

  Contraindicated (2)fluconazole and pimozide both increase QTc interval. Contraindicated.
  
  fluconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)fluconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fludrocortisone

  Minor (1)fludrocortisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluoxetine

  Contraindicated (2)fluoxetine and pimozide both increase QTc interval. Contraindicated.
  
  fluoxetine increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• fluphenazine

  Contraindicated (1)fluphenazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)fluphenazine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  fluphenazine and pimozide both increase sedation. Use Caution/Monitor.

• flurazepam

  Monitor Closely (1)flurazepam and pimozide both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Serious - Use Alternative (2)fluvoxamine increases toxicity of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  fluvoxamine and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• formoterol

  Monitor Closely (1)pimozide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)formoterol and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• fosamprenavir

  Contraindicated (1)fosamprenavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)fosamprenavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosaprepitant

  Contraindicated (1)fosaprepitant increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)fosaprepitant will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Risk of QT interval prolongation.

• foscarnet

  Serious - Use Alternative (1)foscarnet and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• fosphenytoin

  Minor (1)fosphenytoin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fostemsavir

  Monitor Closely (1)pimozide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  Monitor Closely (1)frovatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• gadobenate

  Serious - Use Alternative (1)gadobenate and pimozide both increase QTc interval. Contraindicated.

• ganaxolone

  Monitor Closely (1)pimozide and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Serious - Use Alternative (1)gemifloxacin and pimozide both increase QTc interval. Contraindicated.

• gemtuzumab

  Monitor Closely (1)pimozide and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib and pimozide both increase QTc interval. Contraindicated.

• givosiran

  Serious - Use Alternative (2)givosiran will increase the level or effect of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.
  
  givosiran will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glasdegib

  Serious - Use Alternative (1)pimozide and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• glycerol phenylbutyrate

  Monitor Closely (1)glycerol phenylbutyrate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.

• glycopyrrolate

  Monitor Closely (1)pimozide increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• glycopyrrolate inhaled

  Monitor Closely (3)glycopyrrolate inhaled decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  glycopyrrolate inhaled decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• glycopyrronium tosylate topical

  Monitor Closely (1)glycopyrronium tosylate topical, pimozide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• goserelin

  Contraindicated (1)goserelin increases toxicity of pimozide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• granisetron

  Serious - Use Alternative (1)granisetron and pimozide both increase QTc interval. Contraindicated.

• grapefruit

  Serious - Use Alternative (1)grapefruit increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)grapefruit will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• griseofulvin

  Minor (1)griseofulvin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• guanfacine

  Monitor Closely (1)guanfacine, pimozide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• guselkumab

  Monitor Closely (1)guselkumab, pimozide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• haloperidol

  Contraindicated (1)haloperidol and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)haloperidol and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  haloperidol and pimozide both increase sedation. Use Caution/Monitor.

• henbane

  Monitor Closely (3)henbane decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  henbane decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• histrelin

  Serious - Use Alternative (1)histrelin increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• homatropine

  Monitor Closely (3)homatropine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  homatropine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hydrocodone

  Serious - Use Alternative (1)hydrocodone, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• hydrocortisone

  Minor (1)hydrocortisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydromorphone

  Monitor Closely (1)hydromorphone and pimozide both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  Monitor Closely (1)hydroxyzine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)hydroxyzine and pimozide both increase QTc interval. Contraindicated.

• hyoscyamine

  Monitor Closely (3)hyoscyamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hyoscyamine spray

  Monitor Closely (3)pimozide increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  hyoscyamine spray decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine spray decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

• ibuprofen/famotidine

  Serious - Use Alternative (2)ibuprofen/famotidine, pimozide. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.
  
  pimozide, ibuprofen/famotidine. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug.

• ibutilide

  Contraindicated (1)ibutilide and pimozide both increase QTc interval. Contraindicated.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  Monitor Closely (3)iloperidone and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  iloperidone and pimozide both increase sedation. Use Caution/Monitor.
  
  iloperidone increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.Serious - Use Alternative (1)iloperidone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• imatinib

  Monitor Closely (1)imatinib increases levels of pimozide by decreasing metabolism. Use Caution/Monitor.

• imipramine

  Contraindicated (1)imipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and imipramine both increase sedation. Use Caution/Monitor.

• incobotulinumtoxinA

  Monitor Closely (1)pimozide increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, pimozide. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Contraindicated (1)indapamide and pimozide both increase QTc interval. Contraindicated.

• indinavir

  Serious - Use Alternative (1)indinavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• inotuzumab

  Serious - Use Alternative (1)inotuzumab and pimozide both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• ipratropium

  Monitor Closely (3)ipratropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  ipratropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• isavuconazonium sulfate

  Monitor Closely (2)pimozide will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  isavuconazonium sulfate will increase the level or effect of pimozide by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.

• isoflurane

  Serious - Use Alternative (1)isoflurane and pimozide both increase QTc interval. Contraindicated.

• isoniazid

  Monitor Closely (1)isoniazid will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)isoniazid increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• isoproterenol

  Monitor Closely (1)pimozide increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• istradefylline

  Monitor Closely (1)istradefylline will increase the level or effect of pimozide by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  Contraindicated (1)itraconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Both drugs will increase QT interval. Coadministration of pimozide and itraconazole is contraindicated during and 2 weeks after itraconazole treatment.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketoconazole

  Contraindicated (2)ketoconazole and pimozide both increase QTc interval. Contraindicated.
  
  ketoconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)ketoconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketotifen, ophthalmic

  Monitor Closely (1)pimozide and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lapatinib

  Contraindicated (1)lapatinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)lapatinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)lapatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• larotrectinib

  Minor (1)larotrectinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan

  Monitor Closely (1)lasmiditan, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lemborexant

  Monitor Closely (2)pimozide will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
  
  lemborexant, pimozide. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenacapavir

  Serious - Use Alternative (1)lenacapavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lenvatinib

  Monitor Closely (1)pimozide and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  Contraindicated (1)letermovir increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of letermovir and pimozide is contraindicated due to risk of QT prolongations and torsades de pointes.

• leuprolide

  Contraindicated (1)leuprolide increases toxicity of pimozide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• levalbuterol

  Monitor Closely (1)pimozide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levodopa

  Serious - Use Alternative (1)pimozide decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• levofloxacin

  Serious - Use Alternative (1)levofloxacin and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• levoketoconazole

  Contraindicated (2)levoketoconazole and pimozide both increase QTc interval. Contraindicated.
  
  levoketoconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)levoketoconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levomilnacipran

  Monitor Closely (1)levomilnacipran, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• levorphanol

  Monitor Closely (1)levorphanol and pimozide both increase sedation. Use Caution/Monitor.

• lidocaine

  Serious - Use Alternative (1)lidocaine, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.

• linezolid

  Monitor Closely (1)linezolid, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lisdexamfetamine

  Monitor Closely (1)pimozide increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lisuride

  Serious - Use Alternative (1)pimozide decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.

• lithium

  Monitor Closely (1)lithium, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)lithium and pimozide both increase QTc interval. Contraindicated.

• lofepramine

  Contraindicated (1)lofepramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  Monitor Closely (2)pimozide and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
  
  pimozide and lofexidine both increase sedation. Use Caution/Monitor.

• lomitapide

  Monitor Closely (1)pimozide increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• lonafarnib

  Serious - Use Alternative (1)pimozide will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• lopinavir

  Serious - Use Alternative (1)lopinavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• loprazolam

  Monitor Closely (1)loprazolam and pimozide both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and pimozide both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor Closely (1)lorcaserin, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lorlatinib

  Serious - Use Alternative (1)lorlatinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.

• lormetazepam

  Monitor Closely (1)lormetazepam and pimozide both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (2)loxapine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine and pimozide both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (2)loxapine inhaled and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine inhaled and pimozide both increase sedation. Use Caution/Monitor.

• lumacaftor/ivacaftor

  Serious - Use Alternative (1)lumacaftor/ivacaftor will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.

• lumefantrine

  Contraindicated (1)lumefantrine and pimozide both increase QTc interval. Contraindicated.Minor (1)lumefantrine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lurasidone

  Monitor Closely (1)lurasidone, pimozide. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• macimorelin

  Serious - Use Alternative (1)macimorelin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Contraindicated (1)maprotiline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and maprotiline both increase sedation. Use Caution/Monitor.

• marijuana

  Contraindicated (1)marijuana increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)pimozide and marijuana both increase sedation. Use Caution/Monitor.Minor (1)marijuana will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• mavacamten

  Monitor Closely (1)pimozide will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.

• meclizine

  Monitor Closely (3)meclizine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  meclizine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• mefloquine

  Serious - Use Alternative (1)mefloquine increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• melatonin

  Monitor Closely (1)pimozide and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (2)meperidine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  meperidine and pimozide both increase sedation. Use Caution/Monitor.

• meprobamate

  Monitor Closely (1)pimozide and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (1)pimozide increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  Monitor Closely (1)metaxalone and pimozide both increase sedation. Use Caution/Monitor.

• methadone

  Monitor Closely (2)methadone, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  methadone and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)methadone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• methamphetamine

  Monitor Closely (1)pimozide increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  Monitor Closely (1)methocarbamol and pimozide both increase sedation. Use Caution/Monitor.

• methscopolamine

  Monitor Closely (3)methscopolamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  methscopolamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• methyldopa

  Serious - Use Alternative (1)pimozide decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.

• methylenedioxymethamphetamine

  Monitor Closely (1)pimozide increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylergonovine

  Monitor Closely (1)methylergonovine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• methylphenidate

  Monitor Closely (1)pimozide increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• methylprednisolone

  Minor (1)methylprednisolone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metoclopramide

  Monitor Closely (1)pimozide and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

• metoclopramide intranasal

  Serious - Use Alternative (2)pimozide, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
  
  pimozide increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

• metronidazole

  Serious - Use Alternative (1)metronidazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)metronidazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• mexiletine

  Serious - Use Alternative (1)mexiletine, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.

• miconazole vaginal

  Contraindicated (1)miconazole vaginal increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)miconazole vaginal will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• midazolam

  Monitor Closely (1)midazolam and pimozide both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (2)pimozide will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
  
  midazolam intranasal, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (1)pimozide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  Contraindicated (1)mifepristone increases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index; combination may prolong QT interval .

• milnacipran

  Monitor Closely (1)milnacipran, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• mirtazapine

  Monitor Closely (1)pimozide and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and pimozide both increase QTc interval. Contraindicated.

• mitotane

  Monitor Closely (1)mitotane decreases levels of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mobocertinib

  Serious - Use Alternative (2)mobocertinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
  
  mobocertinib and pimozide both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)pimozide increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (1)morphine and pimozide both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)pimozide and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Contraindicated (1)moxifloxacin and pimozide both increase QTc interval. Contraindicated.

• moxonidine

  Monitor Closely (1)pimozide and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)pimozide and nabilone both increase sedation. Use Caution/Monitor.

• nafcillin

  Minor (1)nafcillin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nalbuphine

  Monitor Closely (1)nalbuphine and pimozide both increase sedation. Use Caution/Monitor.

• naratriptan

  Monitor Closely (1)naratriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• nefazodone

  Contraindicated (1)nefazodone increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)nefazodone will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Contraindicated (1)nelfinavir increases levels of pimozide by decreasing metabolism. Contraindicated. Potential for serious and/or life-threatening reactions (eg, cardiac arrhythmias).Minor (1)nelfinavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nevirapine

  Minor (1)nevirapine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  Serious - Use Alternative (1)nifedipine increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)nifedipine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  Contraindicated (2)nilotinib and pimozide both increase QTc interval. Contraindicated.
  
  nilotinib increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)nilotinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nirmatrelvir

  Contraindicated (1)nirmatrelvir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• nirmatrelvir/ritonavir

  Contraindicated (1)nirmatrelvir/ritonavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• nizatidine

  Serious - Use Alternative (1)nizatidine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• norepinephrine

  Monitor Closely (1)pimozide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  Contraindicated (1)nortriptyline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and nortriptyline both increase sedation. Use Caution/Monitor.

• octreotide

  Contraindicated (1)octreotide and pimozide both increase QTc interval. Contraindicated.

• octreotide (Antidote)

  Contraindicated (1)octreotide (Antidote) and pimozide both increase QTc interval. Contraindicated.

• ofloxacin

  Serious - Use Alternative (1)ofloxacin and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  Monitor Closely (2)olanzapine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  olanzapine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and pimozide both increase QTc interval. Contraindicated.

• oliceridine

  Monitor Closely (1)oliceridine, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• olodaterol inhaled

  Monitor Closely (1)pimozide and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)pimozide and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• olutasidenib

  Serious - Use Alternative (1)olutasidenib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.

• omaveloxolone

  Monitor Closely (1)omaveloxolone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  Contraindicated (1)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for cardiac arrhythmias

• onabotulinumtoxinA

  Monitor Closely (3)onabotulinumtoxinA decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  onabotulinumtoxinA decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• ondansetron

  Serious - Use Alternative (1)pimozide and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• opium tincture

  Monitor Closely (1)opium tincture and pimozide both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (1)orphenadrine and pimozide both increase sedation. Use Caution/Monitor.

• osilodrostat

  Monitor Closely (1)osilodrostat and pimozide both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and pimozide both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  Contraindicated (1)oxaliplatin will increase the level or effect of pimozide by Other (see comment). Contraindicated. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)oxaliplatin and pimozide both increase QTc interval. Contraindicated.

• oxazepam

  Monitor Closely (1)oxazepam and pimozide both increase sedation. Use Caution/Monitor.

• oxcarbazepine

  Minor (1)oxcarbazepine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxybutynin

  Monitor Closely (3)oxybutynin decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin topical

  Monitor Closely (3)oxybutynin topical decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin topical decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin transdermal

  Monitor Closely (3)oxybutynin transdermal decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin transdermal decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxycodone

  Monitor Closely (1)oxycodone and pimozide both increase sedation. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (1)oxymorphone and pimozide both increase sedation. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and pimozide both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• pacritinib

  Serious - Use Alternative (1)pacritinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• palbociclib

  Monitor Closely (1)palbociclib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib

• paliperidone

  Monitor Closely (2)paliperidone and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  paliperidone and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)paliperidone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• pancuronium

  Monitor Closely (3)pancuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pancuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• panobinostat

  Monitor Closely (1)panobinostat will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.Serious - Use Alternative (1)pimozide and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• papaveretum

  Monitor Closely (1)papaveretum and pimozide both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)pimozide and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  Contraindicated (1)paroxetine increases levels of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Contraindicated. Coadministration increases pimozide AUC and Cmax and may result in prolonged QT interval.Monitor Closely (1)paroxetine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pasireotide

  Contraindicated (1)pimozide and pasireotide both increase QTc interval. Contraindicated.

• pazopanib

  Monitor Closely (1)pazopanib and pimozide both increase QTc interval. Modify Therapy/Monitor Closely.

• pentamidine

  Contraindicated (1)pentamidine and pimozide both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (1)pentazocine and pimozide both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• perphenazine

  Contraindicated (1)perphenazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)perphenazine and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  perphenazine and pimozide both increase sedation. Use Caution/Monitor.

• pexidartinib

  Serious - Use Alternative (1)pexidartinib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.

• phendimetrazine

  Monitor Closely (1)pimozide increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenelzine

  Monitor Closely (1)phenelzine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• phenobarbital

  Monitor Closely (1)phenobarbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phentermine

  Monitor Closely (1)pimozide increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  Monitor Closely (1)pimozide increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  Monitor Closely (1)pimozide increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• phenytoin

  Minor (1)phenytoin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pholcodine

  Monitor Closely (1)pimozide and pholcodine both increase sedation. Use Caution/Monitor.

• pimavanserin

  Serious - Use Alternative (1)pimavanserin and pimozide both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

• pirbuterol

  Monitor Closely (1)pimozide increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pitolisant

  Serious - Use Alternative (1)pimozide and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  Serious - Use Alternative (2)pimozide and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
  
  posaconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)posaconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pralidoxime

  Monitor Closely (3)pralidoxime decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pralidoxime decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• pramipexole

  Serious - Use Alternative (1)pimozide decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.

• prednisone

  Minor (1)prednisone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primaquine

  Serious - Use Alternative (1)primaquine and pimozide both increase QTc interval. Contraindicated.

• primidone

  Monitor Closely (1)primidone and pimozide both increase sedation. Use Caution/Monitor.Minor (1)primidone will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• procainamide

  Contraindicated (1)pimozide and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  Monitor Closely (1)procarbazine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• prochlorperazine

  Contraindicated (1)prochlorperazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)pimozide and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and prochlorperazine both increase sedation. Use Caution/Monitor.

• promazine

  Contraindicated (1)promazine and pimozide both increase QTc interval. Contraindicated.

• promethazine

  Contraindicated (1)promethazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (3)promethazine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  pimozide and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  promethazine and pimozide both increase sedation. Use Caution/Monitor.

• propafenone

  Serious - Use Alternative (1)propafenone, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.

• propantheline

  Monitor Closely (3)propantheline decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  propantheline decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• propofol

  Monitor Closely (1)propofol and pimozide both increase sedation. Use Caution/Monitor.

• propylhexedrine

  Monitor Closely (1)pimozide increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  Contraindicated (1)protriptyline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam and pimozide both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (3)pimozide and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and quetiapine both increase sedation. Use Caution/Monitor.
  
  quetiapine, pimozide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  Contraindicated (1)quinidine and pimozide both increase QTc interval. Contraindicated.

• quinine

  Contraindicated (1)pimozide and quinine both increase QTc interval. Contraindicated.

• quinupristin/dalfopristin

  Serious - Use Alternative (1)quinupristin/dalfopristin increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)quinupristin/dalfopristin will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ramelteon

  Monitor Closely (1)pimozide and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Serious - Use Alternative (1)pimozide and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

• rapacuronium

  Monitor Closely (3)rapacuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rapacuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• remimazolam

  Monitor Closely (1)remimazolam, pimozide. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  Serious - Use Alternative (2)ribociclib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  ribociclib and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (1)rifampin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  Minor (1)rifapentine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of pimozide by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• rimabotulinumtoxinB

  Monitor Closely (1)pimozide, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

• risperidone

  Monitor Closely (2)pimozide and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and risperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pimozide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

• ritonavir

  Contraindicated (1)ritonavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)ritonavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rizatriptan

  Monitor Closely (1)rizatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• rocuronium

  Monitor Closely (3)rocuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rocuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• rolapitant

  Contraindicated (1)rolapitant will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Rolapitant moderately inhibits CYP2D6. Coadministration with pimozide, a CYP2D6 substrate, causes a significant increase in pimozide plasma concentration that may result in QT prolongation and torsades de pointes.

• romidepsin

  Serious - Use Alternative (1)pimozide and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

• ropeginterferon alfa 2b

  Monitor Closely (1)ropeginterferon alfa 2b will increase the level or effect of pimozide by Other (see comment). Use Caution/Monitor. Certain proinflammatory cytokines, including interferons, can suppress CYP450 enzymes resulting in increased exposures of some CYP substrates. Therefore, monitor patients who are receiving concomitant drugs that are CYP450 substrates with a narrow therapeutic index from toxicities to such drugs.

• ropinirole

  Serious - Use Alternative (1)pimozide decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

• rucaparib

  Serious - Use Alternative (1)rucaparib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rufinamide

  Minor (1)rufinamide will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib

  Minor (1)pimozide will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  Minor (1)pimozide will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• safinamide

  Serious - Use Alternative (1)pimozide decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

• sage

  Minor (1)pimozide and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (1)pimozide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• saquinavir

  Serious - Use Alternative (2)saquinavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.
  
  saquinavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• schisandra

  Monitor Closely (1)schisandra will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• scopolamine

  Monitor Closely (3)scopolamine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  scopolamine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• scullcap

  Monitor Closely (1)pimozide and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)secobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• selegiline

  Monitor Closely (1)selegiline, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• selinexor

  Serious - Use Alternative (1)selinexor, pimozide. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of pimozide by QTc interval. Use Caution/Monitor.

• sertraline

  Contraindicated (1)sertraline increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.Serious - Use Alternative (1)sertraline and pimozide both increase QTc interval. Contraindicated.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and pimozide both increase QTc interval. Contraindicated.

• shepherd's purse

  Monitor Closely (1)pimozide and shepherd's purse both increase sedation. Use Caution/Monitor.

• siponimod

  Serious - Use Alternative (1)siponimod and pimozide both increase QTc interval. Contraindicated.

• sodium oxybate

  Serious - Use Alternative (1)pimozide, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (2)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of pimozide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of pimozide by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (2)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of pimozide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of pimozide by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• solifenacin

  Monitor Closely (3)solifenacin decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  solifenacin decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Serious - Use Alternative (1)solifenacin and pimozide both increase QTc interval. Contraindicated.

• sorafenib

  Contraindicated (1)sorafenib and pimozide both increase QTc interval. Contraindicated.

• sotalol

  Contraindicated (1)pimozide and sotalol both increase QTc interval. Contraindicated.

• sotorasib

  Serious - Use Alternative (1)sotorasib will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications

• St John's Wort

  Monitor Closely (1)St John's Wort will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  Monitor Closely (3)stiripentol, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
  
  stiripentol, pimozide. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.
  
  stiripentol, pimozide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

• sufentanil

  Monitor Closely (1)sufentanil and pimozide both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Serious - Use Alternative (1)sufentanil SL, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sulfamethoxazole

  Serious - Use Alternative (1)sulfamethoxazole and pimozide both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)sulfamethoxazole decreases levels of pimozide by unspecified interaction mechanism. Minor/Significance Unknown.

• sumatriptan

  Monitor Closely (1)sumatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• sunitinib

  Serious - Use Alternative (1)sunitinib and pimozide both increase QTc interval. Contraindicated.

• tacrolimus

  Serious - Use Alternative (1)tacrolimus and pimozide both increase QTc interval. Contraindicated.

• tapentadol

  Monitor Closely (1)tapentadol and pimozide both increase sedation. Use Caution/Monitor.

• tazemetostat

  Monitor Closely (2)tazemetostat will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  pimozide will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• teclistamab

  Monitor Closely (1)teclistamab will increase the level or effect of pimozide by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.

• tecovirimat

  Monitor Closely (1)tecovirimat will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• teduglutide

  Monitor Closely (1)teduglutide increases levels of pimozide by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

• telavancin

  Serious - Use Alternative (1)pimozide and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

• telotristat ethyl

  Monitor Closely (1)telotristat ethyl will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.

• temazepam

  Monitor Closely (1)temazepam and pimozide both increase sedation. Use Caution/Monitor.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of pimozide by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (1)pimozide increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• teriflunomide

  Monitor Closely (1)teriflunomide decreases levels of pimozide by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tetrabenazine

  Monitor Closely (1)pimozide and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)tetrabenazine and pimozide both increase QTc interval. Contraindicated.

• thioridazine

  Contraindicated (1)thioridazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)pimozide and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  Monitor Closely (2)pimozide and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and thiothixene both increase sedation. Use Caution/Monitor.

• tinidazole

  Monitor Closely (1)pimozide will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tiotropium

  Monitor Closely (3)tiotropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tiotropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• tipranavir

  Contraindicated (1)tipranavir increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)tipranavir will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• tolterodine

  Monitor Closely (3)tolterodine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tolterodine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• topiramate

  Monitor Closely (1)pimozide and topiramate both increase sedation. Modify Therapy/Monitor Closely.Minor (1)topiramate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• toremifene

  Contraindicated (1)pimozide and toremifene both increase QTc interval. Contraindicated. Concurrent use of pimozide with other agents that prolong QTc interval is contraindicated.

• tramadol

  Monitor Closely (1)tramadol and pimozide both increase sedation. Use Caution/Monitor.

• tranylcypromine

  Monitor Closely (1)tranylcypromine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trazodone

  Contraindicated (1)trazodone and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  Monitor Closely (1)triazolam and pimozide both increase sedation. Use Caution/Monitor.

• triclabendazole

  Monitor Closely (1)triclabendazole and pimozide both increase QTc interval. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos and pimozide both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Contraindicated (1)trifluoperazine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (2)pimozide and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and trifluoperazine both increase sedation. Use Caution/Monitor.

• trihexyphenidyl

  Monitor Closely (1)pimozide increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  Serious - Use Alternative (1)pimozide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  Contraindicated (1)trimipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  Monitor Closely (1)triprolidine and pimozide both increase sedation. Use Caution/Monitor.

• triptorelin

  Serious - Use Alternative (1)triptorelin increases toxicity of pimozide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• trofinetide

  Monitor Closely (1)trofinetide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).

• tropisetron

  Serious - Use Alternative (1)pimozide and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.

• trospium chloride

  Monitor Closely (3)trospium chloride decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  trospium chloride decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• tucatinib

  Serious - Use Alternative (1)tucatinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• turmeric

  Monitor Closely (1)turmeric will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)pimozide increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• valbenazine

  Monitor Closely (1)valbenazine and pimozide both increase QTc interval. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)pimozide, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vecuronium

  Monitor Closely (3)vecuronium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  vecuronium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
  
  pimozide increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• venlafaxine

  Monitor Closely (1)venlafaxine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)pimozide and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.

• verapamil

  Contraindicated (1)verapamil increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)verapamil will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)pimozide increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Monitor Closely (1)vilazodone, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• voclosporin

  Monitor Closely (1)voclosporin, pimozide. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Contraindicated (2)voriconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  voriconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Serious - Use Alternative (1)pimozide and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  Serious - Use Alternative (1)vorinostat and pimozide both increase QTc interval. Contraindicated.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• xylometazoline

  Monitor Closely (1)pimozide increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  Monitor Closely (1)pimozide increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• zafirlukast

  Serious - Use Alternative (1)zafirlukast increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Minor (1)zafirlukast will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ziconotide

  Monitor Closely (1)pimozide and ziconotide both increase sedation. Use Caution/Monitor.

• zileuton

  Serious - Use Alternative (1)zileuton increases levels of pimozide by decreasing metabolism. Contraindicated. May prolong QTc interval.

• ziprasidone

  Contraindicated (1)pimozide and ziprasidone both increase QTc interval. Contraindicated.Monitor Closely (2)pimozide and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and ziprasidone both increase sedation. Use Caution/Monitor.

• zolmitriptan

  Monitor Closely (1)zolmitriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• zotepine

  Monitor Closely (2)pimozide and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and zotepine both increase sedation. Use Caution/Monitor.