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.metronidazoleSerious - 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.mexiletineSerious - Use Alternative (1)mexiletine, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.miconazole vaginalContraindicated (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.midazolamMonitor Closely (1)midazolam and pimozide both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor 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.midodrineMonitor Closely (1)pimozide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mifepristoneContraindicated (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 .milnacipranMonitor 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).mirtazapineMonitor Closely (1)pimozide and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and pimozide both increase QTc interval. Contraindicated.mitotaneMonitor 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.mobocertinibSerious - 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.modafinilMonitor Closely (1)pimozide increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (1)morphine and pimozide both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)pimozide and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinContraindicated (1)moxifloxacin and pimozide both increase QTc interval. Contraindicated.moxonidineMonitor Closely (1)pimozide and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)pimozide and nabilone both increase sedation. Use Caution/Monitor.nafcillinMinor (1)nafcillin will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.nalbuphineMonitor Closely (1)nalbuphine and pimozide both increase sedation. Use Caution/Monitor.naratriptanMonitor 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).nefazodoneContraindicated (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.nelfinavirContraindicated (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.nevirapineMinor (1)nevirapine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.nifedipineSerious - 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.nilotinibContraindicated (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.nirmatrelvirContraindicated (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/ritonavirContraindicated (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.nizatidineSerious - Use Alternative (1)nizatidine will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.norepinephrineMonitor Closely (1)pimozide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineContraindicated (1)nortriptyline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and nortriptyline both increase sedation. Use Caution/Monitor.octreotideContraindicated (1)octreotide and pimozide both increase QTc interval. Contraindicated.octreotide (Antidote)Contraindicated (1)octreotide (Antidote) and pimozide both increase QTc interval. Contraindicated.ofloxacinSerious - Use Alternative (1)ofloxacin and pimozide both increase QTc interval. Avoid or Use Alternate Drug.olanzapineMonitor 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.oliceridineMonitor 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 inhaledMonitor 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 arrhythmiasolopatadine intranasalSerious - 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. olutasidenibSerious - 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.omaveloxoloneMonitor 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 arrhythmiasonabotulinumtoxinAMonitor 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.ondansetronSerious - 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 tinctureMonitor Closely (1)opium tincture and pimozide both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (1)orphenadrine and pimozide both increase sedation. Use Caution/Monitor.osilodrostatMonitor Closely (1)osilodrostat and pimozide both increase QTc interval. Use Caution/Monitor.osimertinibMonitor 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.oxaliplatinContraindicated (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.oxazepamMonitor Closely (1)oxazepam and pimozide both increase sedation. Use Caution/Monitor.oxcarbazepineMinor (1)oxcarbazepine will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.oxybutyninMonitor 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 topicalMonitor 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 transdermalMonitor 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.oxycodoneMonitor Closely (1)oxycodone and pimozide both increase sedation. Use Caution/Monitor.oxymorphoneMonitor Closely (1)oxymorphone and pimozide both increase sedation. Use Caution/Monitor.ozanimodMonitor 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.pacritinibSerious - Use Alternative (1)pacritinib will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.palbociclibMonitor 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 palbociclibpaliperidoneMonitor 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.pancuroniumMonitor 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.panobinostatMonitor 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.papaveretumMonitor Closely (1)papaveretum and pimozide both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)pimozide and papaverine both increase sedation. Use Caution/Monitor.paroxetineContraindicated (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).pasireotideContraindicated (1)pimozide and pasireotide both increase QTc interval. Contraindicated.pazopanibMonitor Closely (1)pazopanib and pimozide both increase QTc interval. Modify Therapy/Monitor Closely.pentamidineContraindicated (1)pentamidine and pimozide both increase QTc interval. Contraindicated.pentazocineMonitor Closely (1)pentazocine and pimozide both increase sedation. Use Caution/Monitor.pentobarbitalMonitor 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.perphenazineContraindicated (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.pexidartinibSerious - 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