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pipamperone

N05AD05

Forms & Strengths

Oral tablets 5 mg
Oral tablets 10 mg
Oral tablets 20 mg
Oral solution 5 mg/mL

Adult Dosing

Schizophrenia: start 5‑10 mg 2–3×/day, titrate to 30‑60 mg/day
Acute agitation: 10‑20 mg single dose, may repeat after 4 h
Anxiety/insomnia: 5‑10 mg at bedtime
Maximum usual dose 150 mg/day
Adjust for hepatic impairment: reduce dose by 25‑50%

Pediatric Dosing

Not routinely approved; limited data
Children ≥12 y with severe agitation: start 5 mg once daily
Maximum 10 mg/day in this age group
Use only when benefits outweigh risks

Indications

Schizophrenia and related psychotic disorders
Acute agitation and hostility
Severe anxiety states
Insomnia associated with psychosis
Adjunct in refractory depression

Mechanism of Action

Antagonist at dopamine D2 receptors
Blocks serotonin 5‑HT2A receptors
Antihistamine H1 receptor blockade
Alpha‑1 adrenergic antagonism
Low‑potency typical antipsychotic profile

Contraindications

Known hypersensitivity to pipamperone
Severe CNS depression or coma
Narrow‑angle glaucoma
Uncontrolled cardiovascular disease (e.g., recent MI)
Concurrent use of MAO‑inhibitors

Adverse Reactions

Sedation and somnolence
Orthostatic hypotension
Extrapyramidal symptoms (parkinsonism, akathisia)
Anticholinergic effects (dry mouth, constipation)
Weight gain and metabolic changes
Hyperprolactinemia
QT‑interval prolongation

Drug Interactions

Additive CNS depression with alcohol, benzodiazepines, opioids
CYP2D6 inhibitors (e.g., fluoxetine) ↑ pipamperone levels
CYP3A4 inducers (e.g., rifampin) ↓ pipamperone exposure
Other QT‑prolonging agents increase torsades risk
Concurrent dopamine antagonists raise EPS risk
Anticholinergic drugs enhance anticholinergic burden

Curated Content: Needs Vetting Before Put to Clinical Use