American Journal of Clinical Dermatology

, Volume 5, Issue 5, pp 339–349 | Cite as

Pimozide in Dermatologic Practice

A Comprehensive Review
  • Cynthia R. LorenzoEmail author
  • John Koo
Review Article


Pimozide is an antipsychotic drug of the diphenylbutylpiperidine class. In the US, it is FDA-approved only as a backup treatment for Gilles de la Tourette syndrome, although it has been used in other countries for many years as a treatment for schizophrenia. In the past 20 years, pimozide has been found to be especially efficacious in the treatment of monosymptomatic hypochondriacal psychoses and is used by psychiatrists and dermatologists for this off-label purpose. In particular, pimozide is considered the treatment of choice for delusions of parasitosis. In addition, pimozide has been found to be efficacious in the treatment of body dysmorphic disorder, metastatic melanoma, trichotillomania, and trigeminal and postherpetic neuralgia. This review aims to familiarize physicians, especially dermatologists, on the uses of pimozide in dermatologic practice. A review of the literature was performed and the relevant information synthesized to give a complete overview of the drug and its therapeutic uses in dermatology.


Naltrexone Tardive Dyskinesia Trigeminal Neuralgia Pimozide Postherpetic Neuralgia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Janssen PAJ, Brugmans J, Dony J, et al. An international double-blind clinical evaluation of pimozide. J Clin Pharmacol 1972; 12: 26–34Google Scholar
  2. 2.
    Janssen PAJ, Niemegeers CJE, Schellekens KHL, et al. Pimozide: a chemically novel, highly potent and orally acting neuroleptic drug. Arzneimittel Forschung 1968; 18: 261–87PubMedGoogle Scholar
  3. 3.
    Tennyson H, Levine N. Neurotropic and psychotropic drugs in dermatology. Dermatol Clin 2001; 19: 179–97PubMedGoogle Scholar
  4. 4.
    Opler LA, Feinberg SS. The role of pimozide in clinical psychiatry: a review. J Clin Psychiatry 1991; 52: 221–33PubMedGoogle Scholar
  5. 5.
    Richelson E. Receptor pharmacology of neuroleptics: relation to clinical effects. J Clin Psychiatry 1999; 60 Suppl. 10: 5–14PubMedGoogle Scholar
  6. 6.
    Gould R, Murphy K, Reynolds I, et al. Antischizophrenic drugs of the diphenylbutylpiperidine type act as calcium channel antagonists. Proc Natl Acad Sci U S A 1983; 80: 5122–5PubMedCrossRefGoogle Scholar
  7. 7.
    Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain 1988; 33: 149–60PubMedCrossRefGoogle Scholar
  8. 8.
    Creese I, Feinberg AP, Snyder SH. Butyrophenone influences on the opiate receptor. Eur J Pharmacol 1976; 36: 231–5PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen ML, Carpenter R, Schenck K, et al. Effect of nitrendipine, diltiazem, trifluoperazine and pimozide on serotonin2 (5-HT2) receptor activation in the rat uterus and jugular vein. J Pharmacol Exper Therap 1986; 238: 860–7Google Scholar
  10. 10.
    Kapur S. 5-HT2 antagonism and EPS benefits: is there a causal connection? Psychopharmacology 1996; 124: 35–9PubMedCrossRefGoogle Scholar
  11. 11.
    Seeman P. Atypical antipsychotics: mechanism of action. Can J Psychiatry 2002; 47: 27–38PubMedGoogle Scholar
  12. 12.
    Driscoll MS, Rothe MJ, Grant-Kels JM, et al. Delusional parasitosis: a dermatologic, psychiatric and pharmacologic approach. J Am Acad Dermatol 1993; 29: 1023–33PubMedCrossRefGoogle Scholar
  13. 13.
    Pinder R, Brogden P, Sawyer P, et al. Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry. Drugs 1976; 12: 1–40PubMedCrossRefGoogle Scholar
  14. 14.
    The Scottish Schizophrenic Research Group. The Scottish first episode schizophrenia study: II. Treatment: pimozide versus flupenthixol. Br J Psychiatry 1987; 150: 334–8CrossRefGoogle Scholar
  15. 15.
    Koo J, Lee CS. Delusions of parasitosis; a dermatologist’s guide to diagnosis and treatment. Am J Clin Dermatol 2001; 2: 285–90PubMedCrossRefGoogle Scholar
  16. 16.
    Lindskov R, Baadsgaard O. Delusions of infestation treated with pimozide. Acta Derm Venereol 1985; 65: 267–70PubMedGoogle Scholar
  17. 17.
    Chouinard G, Lehmann HE, Ban TA. Pimozide in the treatment of chronic schizophrenic patients. Curr Ther Res 1970; 12: 598–603PubMedGoogle Scholar
  18. 18.
    Fulop G, Phillips RA, Shapiro AK, et al. ECG changes during haloperidol and pimozide treatment of Tourette’s disorder. Am J Psychiatry 1987; 144: 673–5PubMedGoogle Scholar
  19. 19.
    Shapiro AK, Shapiro E, Fulop G. Pimozide treatment of tic and Tourette disorders. Pediatrics 1987; 79: 1032–9PubMedGoogle Scholar
  20. 20.
    Tueth MJ, Cheong JA. Clinical uses of pimozide. South Med J 1993; 86: 344–9PubMedCrossRefGoogle Scholar
  21. 21.
    Shopsin B, Selzer G. High-dose pimozide in acutely ill, newly admitted schizophrenic inpatients. Curr Ther Res 1977; 21: 755–67Google Scholar
  22. 22.
    Shatzberg AF, Cole JO, Degattista C. Manual of clinical psychopharmacology. 3rd ed. Washington, DC: American Psychiatric Association, 1997: 154–155Google Scholar
  23. 23.
    Glassman AH, Bigger JT. Antipsychotic drugs: prolonged QTc interval, torsades de pointes, and sudden death. Am J Psychiatry 2001; 158: 1774–82PubMedCrossRefGoogle Scholar
  24. 24.
    Task force on DSM-IV. Diagnostic and statistical manual of mental disorders: text revision. 4th ed. Washington, DC: American Psychiatric Association, 2000Google Scholar
  25. 25.
    Phillips KA. Pharmacologic treatment of body dysmorphic disorder: review of the evidence and a recommended treatment approach. CNS Spectr 2002; 7: 453–63PubMedGoogle Scholar
  26. 26.
    Phillips KA. Pharmacologic treatment of body dysmorphic disorder. Psychopharmacol Bull 1996; 32: 597–605PubMedGoogle Scholar
  27. 27.
    Hamann K, Avnstrop C. Delusions of infestation treated by pimozide: a double blind crossover clinical study. Acta Derm Venereol 1982; 62: 55–8PubMedGoogle Scholar
  28. 28.
    Ungvari G, Vladar K. Pimozide treatment for delusion of infestation. Act Nerv Super (Praha) 1986; 28: 103–7Google Scholar
  29. 29.
    Munro A, Mok H. An overview of treatment in paranoia/delusional disorder. Can J Psychiatry 1995; 40: 616–22PubMedGoogle Scholar
  30. 30.
    Reilly T, Batchelor D. The presentation and treatment of delusional parasitosis: a dermatological perspective. Int Clin Psychopharmacol 1986; 1: 340–53PubMedCrossRefGoogle Scholar
  31. 31.
    Johnson GC, Anton RF. Pimozide in delusions of parasitosis [letter]. J Clin Psychiatry 1983; 44: 233PubMedGoogle Scholar
  32. 32.
    Munro A. Monosymptomatic hypochondriacal psychosis manifesting as delusions of parasitosis. Arch Dermatol 1978; 114: 940–3PubMedCrossRefGoogle Scholar
  33. 33.
    Riding J, Munro A. Pimozide in the treatment of monosymptomatic hypochondriacal psychosis. Acta Psychiatr Scand 1975; 52: 23–30PubMedCrossRefGoogle Scholar
  34. 34.
    Zanol K, Slaughter J, Hall R. An approach to the treatment of psychogenic parasitosis. Int J Dermatol 1998; 37: 56–63PubMedCrossRefGoogle Scholar
  35. 35.
    Damiani JT, Flowers FP, Pierce DK. Pimozide in delusions of parasitosis. J Am Acad Dermatol 1990; 22: 312–3PubMedCrossRefGoogle Scholar
  36. 36.
    Lyell A. Delusions of parasitosis. Br J Dermatol 1983; 108: 485–99PubMedCrossRefGoogle Scholar
  37. 37.
    Sheppard N, O’Loughlin S, Malone J. Psychogenic skin disease: a review of 35 cases. Br J Psychiatry 1986; 149: 636–43PubMedCrossRefGoogle Scholar
  38. 38.
    Zomer SF, De Wit RF, Van Bonswijk JE, et al. Delusions of parasitosis: a psychiatric disorder to be treated by dermatologists?. An analysis of 33 patients. Br J Dermatol 1998; 138: 1030–2PubMedCrossRefGoogle Scholar
  39. 39.
    Koo J, Gambla C. Delusions of parasitosis and other forms of monosymptomatic hypochondriacal psychosis. Dermatol Clin 1996; 14: 429–38PubMedCrossRefGoogle Scholar
  40. 40.
    Elmer KB, George RM, Peterson K. Therapeutic update: use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis. J Am Acad Dermatol 2000; 43: 683–6PubMedCrossRefGoogle Scholar
  41. 41.
    De Leon OA, Furmaga KM, Canterbury AL, et al. Risperidone in the treatment of delusions of infestation. Int J Psychiatry Med 1997; 27: 403–9PubMedCrossRefGoogle Scholar
  42. 42.
    Moretti M. Psychosomatic dermatologic symptoms (Hungarian). Orv Hetil 2000; 141: 169–72PubMedGoogle Scholar
  43. 43.
    Freyne A. Delusions of infestation: a case report of response to risperidone. Ir Med J 1999; 92: 435PubMedGoogle Scholar
  44. 44.
    Gallucci G. Risperidone and the treatment of delusions of parasitosis in an elderly patient. Psychosomatics 1995; 36: 578–80PubMedCrossRefGoogle Scholar
  45. 45.
    Cetin M, Agargun MY, Yigit S. Risperidone for the treatment of monosymptomatic hypochondriacal psychosis. J Clin Psychiatry 1999; 60: 554PubMedCrossRefGoogle Scholar
  46. 46.
    Safer DL, Roth WT. Risperidone in the treatment of delusional parasitosis: a case report. J Clin Psychopharmacol 1997; 17: 131–2PubMedCrossRefGoogle Scholar
  47. 47.
    Weintraub E. A case of monosymptomatic hypochondriacal psychosis treated with olanzapine. Ann Clin Psychiatry 2000; 12: 247–9PubMedGoogle Scholar
  48. 48.
    Fawcett RG. Olanzapine for the treatment of monosymptomatic hypochondriacal psychosis [letter]. Clin Psychiatry 2002; 63: 169CrossRefGoogle Scholar
  49. 49.
    Yorston G. Treatment of delusional parasitosis with sertindole. Int J Geriatr Psychiatry 1997; 12: 1127–8PubMedCrossRefGoogle Scholar
  50. 50.
    Hopkinson G. The psychiatric syndrome of infestation. Psychiatr Clin 1973; 6: 330–45Google Scholar
  51. 51.
    King BH. Hypothesis: involvement of the serotonergic system in the clinical expression of monosymptomatic hypochondriasis. Pharmacopsychiatry 1990; 23: 85–9PubMedCrossRefGoogle Scholar
  52. 52.
    Botschev C, Müller N. Opiate receptor antagonist for delusions of parasitosis. Biol Psychiatry 1991; 30: 530–1PubMedCrossRefGoogle Scholar
  53. 53.
    Fernandez A. Pimozide in delusional dysmorphosis. Can J Psychiatry 1988; 33: 425–6PubMedGoogle Scholar
  54. 54.
    Dorian BJ. Monosymptomatic hypochondriacal psychosis [letter]. Can J Psychiatry 1979; 24: 377Google Scholar
  55. 55.
    Pollock BG. Successful treatment of pathological jealousy with pimozide. Can J Psychiatry 1982; 27: 86–7PubMedGoogle Scholar
  56. 56.
    Munro A. Excellent response of pathological jealousy with pimozide. CMAJ 1984; 131: 852–3Google Scholar
  57. 57.
    Byrne A, Yatham LN. Pimozide in pathological jealousy. Br J Psychiatry 1989; 155: 249–51PubMedCrossRefGoogle Scholar
  58. 58.
    Lane RD. Successful fluoxetine treatment of pathologic jealousy. J Clin Psychiatry 1990; 51: 345–6PubMedGoogle Scholar
  59. 59.
    Stein DJ, Hollander E, Josephson SC. Serotonin reuptake blockers for the treatment of obsessional jealousy. J Clin Psychiatry 1994; 55: 30–3PubMedGoogle Scholar
  60. 60.
    Munro A, O’Brian JV, Ross D. Two cases of “pure” or “primary” erotomania successfully treated with pimozide. Can J Psychiatry 1985; 30: 619–22PubMedGoogle Scholar
  61. 61.
    Costanza ME, Nathanson L, Schoenfeld D, et al. Results with methyl-CCNU and DTIC in metastatic melanoma. Cancer 1977; 40: 1010–5PubMedCrossRefGoogle Scholar
  62. 62.
    Rigel DS, Murray T, Bolden S, et al. Malignant melanoma: prevention, early detection and treatment in the 21st Century. CA Cancer J Clin 2000; 50: 215–30PubMedCrossRefGoogle Scholar
  63. 63.
    Cohen GL, Falkson CI. Current treatment options for malignant melanoma. Drugs 1998; 55: 791–9PubMedCrossRefGoogle Scholar
  64. 64.
    Wick MM, Byers L, Frei E. L-Dopa: selective toxicity for melanoma cells in vitro. Science 1977; 197: 468–9PubMedCrossRefGoogle Scholar
  65. 65.
    Wick MM, Byers L, Frei E. Dopamine: a novel antitumor agent active against B-16 melanoma in vivo. J Invest Dermatol 1978; 71: 163–4PubMedGoogle Scholar
  66. 66.
    Wick MM, Byers L, Frei E. Therapeutic effect of dopamine infusion on human malignant melanoma. Cancer Treat Rep 1982; 66: 1657–9PubMedGoogle Scholar
  67. 67.
    Taub RN, Baker MA. Treatment of metastatic malignant melanoma with pimozide. Lancet 1979; I: 605CrossRefGoogle Scholar
  68. 68.
    Neifeld JP, Tormey DC, Baker MA, et al. Phase II trial of the dopaminergic inhibitor pimozide in previously treated melanoma patients. Cancer Treat Rep 1983; 67: 155–7PubMedGoogle Scholar
  69. 69.
    Krummel TM, Neifeld JP, Taub RN. Effects of dopamine agonists and antagonists on murine melanoma. Cancer 1982; 49: 1178–84PubMedCrossRefGoogle Scholar
  70. 70.
    Stein DJ, Hollander E. Low dose augmentation of serotonin reuptake blockers in the treatment of trichotillomania. J Clin Psychiatry 1992; 53: 123–6PubMedGoogle Scholar
  71. 71.
    Delzell JEJ, Grelle AR. Trigeminal neuralgia: new treatment options for a well-known cause of facial pain. Arch Fam Med 1999; 8: 264–8PubMedCrossRefGoogle Scholar
  72. 72.
    Lechin F, van der Dijs B, Lechin ME, et al. Pimozide therapy for trigeminal neuralgia. Arch Neurol 1989; 46: 960–3PubMedCrossRefGoogle Scholar
  73. 73.
    Sindrup SH, Jensen TS. Pharmacotherapy of trigeminal neuralgia. Clin J Pain 2002; 18: 22–7PubMedCrossRefGoogle Scholar
  74. 74.
    Duke EE. Clinical experience with pimozide: emphasis on its use in postherpetic neuralgia. J Am Acad Dermatol 1983; 8: 845–50PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.Department of DermatologyUniversity of CincinnatiCincinnatiUSA
  2. 2.Department of DermatologyUniversity of CaliforniaSan FranciscoUSA

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