Mozep
Mozep (Pimozide 2 mg) — butyrophenone antipsychotic for refractory Tourette syndrome and delusional disorder. strong dose-dependent QT — pre-treatment ECG mandatory.
✓ Orvosi ellenőrzés Morgan Ellis — Gyógyszerkutató · 8 év tapasztalat · Utolsó felülvizsgálat: 2026 május
⚡ Gyors válasz
Mozep (Pimozide 2 mg) is a butyrophenone first-generation antipsychotic. Modern use is restricted to refractory Tourette syndrome (with motor and vocal tics) and treatment-resistant delusional disorder. Strong dose-dependent QT prolongation and torsades risk — pre-treatment ECG mandatory.
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What Mozep is and how it works
Mozep is a pimozide tablet supplied by Sun Pharma. Available strengths: 2 mg. Pimozide is a butyrophenone (related to haloperidol) with selective D2 antagonism, modest 5-HT2A antagonism, and meaningful calcium-channel blockade — the latter is the basis for the QT-prolonging effect that limits its use.
Modern indications: refractory Tourette syndrome (FDA approval), monosymptomatic delusional disorder (e.g. delusions of parasitosis, somatic delusions), and rare schizophrenia cases unresponsive to other agents.
What Agoprex is and how it works
| Agoprex is a 25 mg agomelatine tablet supplied by Sun Pharma. Agomelatine is mechanistically unique among antidepressants: it acts as an agonist at melatonin MT1 and MT2 receptors and an antagonist at 5-HT2C serotonin receptors. The dual mechanism resynchronises disrupted circadian rhythms (a feature of major depression) while indirectly increasing dopamine and noradrenaline release in the frontal cortex. | Agomelatine has no SERT activity, no anticholinergic effects, and no histaminergic effects — explaining its very different side-effect profile from SSRIs and TCAs. | Indications and dosing | Indication |
|---|---|---|---|
| Tourette syndrome (adult) | 1 mg HS | 1–10 mg/day | 0.2 mg/kg or 10 mg |
| Tourette syndrome (paediatric ≥ 12 y) | 0.05 mg/kg HS | 0.2 mg/kg/day | 0.2 mg/kg or 10 mg |
| Monosymptomatic delusional disorder | 2 mg OD | 2–4 mg/nap | — |
| Schizophrenia (refractory) | 1 mg BID | 2–10 mg/day | 20 mg |
| CYP2D6 poor metaboliser / inhibitor | féldózis | — | — |
Fontos biztonsági megfontolások
Az összes atípusos antipszichotikum hordoz egy FDA fekete doboz figyelmeztetést a megnövekedett halálozási kockázat miatt (főleg cardiovascularis és fertőzéses okokból), amikor idős, demenciában szenvedő betegek viselkedészavarainak kezelésére használják. Az atípusos antipszichotikumok nincsenek jóváhagyva demenciával összefüggő pszichózis vagy agitáció kezelésére. Használatuk ebben a populációban off-label, utolsó lehetőség, időkorlátozott, és kifejezett kockázat-haszon beszélgetést igényel.
Pimozide carries a strong dose-dependent QT signal. Pre-treatment ECG required; check QTc at every dose increase; stop if QTc > 500 ms or rises > 60 ms from baseline. Absolute contraindications: known long QT, congenital arrhythmia syndrome, recent MI, uncompensated heart failure, hypokalaemia/hypomagnesaemia (correct before starting), concurrent QT-prolonging drugs, and concurrent strong CYP3A4 inhibitors (azoles, clarithromycin, ritonavir, grapefruit juice — all raise pimozide levels and the QT signal substantially).
Pimozide is metabolised by both CYP3A4 and CYP2D6. Strong inhibitors of either enzyme raise levels and amplify QT risk. Strong CYP2D6 inhibitors (paroxetine, fluoxetine, bupropion, quinidine) and strong CYP3A4 inhibitors are absolute contraindications.
As a butyrophenone, pimozide produces meaningful EPS, akathisia, acute dystonia (particularly in young men), and cumulative tardive dyskinesia. Anticholinergic adjunct (procyclidine, benztropine) sometimes used acutely.
Gyakori mellékhatások
- QT-intervallum meghosszabbodás — dose-dependent, monitored continuously.
- EPS, akathisia, dystonia – gyakori.
- Sedation — moderate.
- Hyperprolaktinaemia — strong.
- Anticholinergic — dry mouth, constipation, urinary hesitancy.
- Súlygyarapodás – mérsékelt.
- Tardive dyskinesia — cumulative.
Gyógyszerkölcsönhatások
- Erős CYP3A4 gátlók (azoles, clarithromycin, ritonavir, grapefruit juice) — absolute contraindication.
- Erős CYP2D6 gátlók (paroxetine, fluoxetine, bupropion, quinidine) — absolute contraindication.
- Egyéb QT-idejét meghosszabbító gyógyszerek — absolute or relative contraindication depending on agent.
- Other antipsychotics — additive QT, EPS, prolactin risk.
- Sertraline / escitalopram — these are the safer SSRIs to combine with pimozide if absolutely necessary (less CYP2D6 inhibition than paroxetine/fluoxetine).
Terhesség, szoptatás, gyermekkori kor
Pregnancy: limited data; not first-line. Breastfeeding: passes into milk; usually avoided. Paediatric: licensed from 12 (Tourette syndrome).
Tárolás
15–30 °C között tároljuk eredeti csomagolásban.
Gyakran Ismételt Kérdések
Why is Mozep so restricted in modern psychiatry?
Pimozide’s strong dose-dependent QT prolongation, dual CYP3A4/CYP2D6 metabolism, and dense interaction profile mean it carries a higher cardiac-risk burden than most modern antipsychotics. Its modern niche is therefore narrow — refractory Tourette syndrome and monosymptomatic delusional disorder where other agents have failed.
Why is Mozep useful for delusional parasitosis?
Monosymptomatic delusional disorder (delusions of parasitosis, somatic delusions, delusions of body odour) responded particularly well to pimozide in older case series — possibly because of the strong selective D2 blockade. Modern practice often prefers a low-dose atypical (risperidone, olanzapine) but pimozide retains a niche where atypicals have failed.
Why pre-treatment ECG?
Pimozide’s QT prolongation is the dose-limiting toxicity. A baseline ECG defines the patient’s starting QTc; the prescriber checks QTc at every dose increase. Stop or dose-reduce if QTc > 500 ms or rises > 60 ms from baseline. This is non-negotiable.
Why avoid grapefruit juice?
Grapefruit juice strongly inhibits intestinal CYP3A4 — pimozide levels rise several-fold, amplifying the QT signal into the dangerous range. Grapefruit and grapefruit juice are absolute contraindications during pimozide therapy.
Can Mozep be combined with an SSRI?
Most SSRIs are absolute or relative contraindications because of CYP2D6 inhibition (paroxetine, fluoxetine, bupropion). Sertraline and escitalopram are the safer SSRIs if combination is necessary, but ECG monitoring is still required.
How long until Mozep works?
Tic reduction often visible within 1–2 weeks of titration. Full effect at 4–6 weeks. Delusional disorder: 4–8 weeks.
Can Mozep be stopped abruptly?
Taper over 2–4 weeks. Cholinergic rebound and tic rebound (in Tourette) can be problematic on abrupt cessation.
Will Mozep cause weight gain?
Modest — typically 1–3 kg over 6 months.
What about driving on Mozep?
Sedation is moderate. Most patients on stable doses drive normally; first 1–2 weeks of titration can impair reaction time.
Are there alternatives to Mozep for Tourette?
Yes — aripiprazole, risperidone, and clonidine/guanfacine are commonly used. Most patients respond to one of these without needing pimozide. Pimozide is reserved for refractory cases.
Egyéb Pszichés Egészségügyi Gyógyszerek
- Aripicon (Aripiprazole — atypical, low EPS)
- Risdone (Risperidon)
- Olanzap (Olanzapine)
- Sulpitac (Amisulpride)
- Skizoril (Clozapine — refractory disease)
További lehetőségek a Pszichés Egészségügyi és Pszichiátriai Gyógyszerek között
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| Erősség | 2 mg |
|---|---|
| Mennyiség | 30 tabletta, 60 tabletta, 90 tabletta, 180 tabletta |
Mozep
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