Indications 

Orap is a prescribed medication used to reduce motor (physical) and phonic (vocal) tics in patients with Tourette’s Disorder who have not responded adequately to conventional therapy. 

Classified as a conventional antipsychotic, Orap works by reducing the activity of dopamine, a naturally occurring substance in the brain. 

Orap is neither recommended as a first-line treatment nor intended to manage tics that are simply bothersome or cosmetically troubling. It should be exclusively used for individuals with Tourette’s Disorder whose motor and vocal tics significantly impede their daily functioning and development. 

Uses and Dosage 

Before taking Orap and with every prescription refill, carefully review its medication guide and information leaflet. Ask your physician or pharmacist if you have any questions. 

The dosage of Orap is determined by the patient’s medical condition, laboratory tests, and treatment response. 

Initially, your doctor may prescribe a low dose, gradually increasing it to minimize the risk of side effects such as tremors. If your condition is under control, the dosage may be lowered. Keep your doctor informed about your progress while taking this medication. 

Typically, Orap is taken once daily at bedtime or multiple times throughout the day, irrespective of food consumption. 

For optimal results, take Orap exactly as directed, around the same times daily.  Avoid taking it more frequently or in higher doses, as doing so will not speed up symptom relief but could heighten the likelihood of heart rhythm issues. 

Consult your doctor before discontinuing this medication, as sudden cessation may exacerbate your condition. Gradual dose reduction may be necessary. 

Side Effects 

Listed below are the potential adverse effects of Orap. If any of them persist or worsen, inform your doctor immediately. 

Common Side Effects 

• Speech or vision issues 
• Drowsiness  
• Difficulty sleeping 
• Restlessness 
• Muscle tightness 
• Constipation 

• Dry mouth 

Serious Side Effects 

• Uncontrolled muscle movements in the face (chewing, lip smacking, frowning, tongue movement, blinking, or eye movement) 
• Fast or pounding heartbeats, fluttering in the chest, shortness of breath, and sudden dizziness 
• Fever, chills, tiredness, mouth sores, and skin sores 
• Seizures (convulsions) 
• Severe nervous system reaction: 
  • Very stiff (rigid) muscles 
  • High fever 
  • Sweating 
  • Confusion 
  • Fast or uneven heartbeats 
  • Tremors 
  • Feeling like you might pass out 

Notify your doctor right away if any of the severe side effects listed above are experienced. 

Prolonged use or high doses of Orap can lead to an irreversible movement disorder, particularly in older adults. 

Allergic Reactions 

Although rare, a severe allergic reaction to Orap may occur. Get immediate medical help if you observe any of the following symptoms: 

• Hives 
• Swelling (face, lips, tongue, or throat) 
• Breathing difficulty 

Not all side effects of Orap are included in this list. Inform your doctor promptly if any unlisted effects are observed. 

Cautions 

Before starting treatment with Orap, inform your doctor of any known allergies, particularly to pimozide, other drugs, or any of the components of Orap tablets. 

To ensure Orap is safe for you, disclose to your physician your medical background, especially if you have a history of: 

• Blood problems, such as low white blood cell count 
• Glaucoma (a specific eye condition) 
• Dementia 
• Depression 
• Heart problems, including slow/fast/irregular heartbeat or low blood pressure 
• Slow movement of the gut/intestines, such as chronic constipation or blockage 
• Kidney disease 
• Liver disease 
• Brain disorder, tumor, or injury 
• History of drug/alcohol/substance abuse 
• Breast cancer 
• Parkinson’s disease 
• Seizure disorder 
• Previous severe reaction to other antipsychotic-type medications (neuroleptic malignant syndrome-NMS) 
• Difficulty urinating, such as due to prostate problems 

To minimize the possibility of drug interaction with Orap, disclose all current and future use of prescription and non-prescription medications, vitamins, and herbal supplements to your doctor and pharmacist. 

Some of the products that may interact with Orap include: 

• Anticholinergic/antispasmodic drugs, such as: 
  • Atropine 
  • Dicyclomine 
  • Scopolamine 
• Drugs that increase dopamine levels in the body, such as: 
  • Bromocriptine 
  • Cabergoline 
  • Levodopa 
  • Pergolide 
  • Ropinirole 

The effectiveness of Orap may be impacted by other drugs that affect its removal from the body. These drugs include: 

• Aprepitant 
• Azole antifungals (ketoconazole, itraconazole) 
• HIV protease inhibitors (nelfinavir) 
• Nefazodone 
• SSRI antidepressants (fluvoxamine, paroxetine, sertraline) 
• Ritonavir 
• Zileuton  

Ensure to review the labels of all your medications, including allergy and cough-and-cold products, as they may contain ingredients that induce drowsiness. Consult your pharmacist to ensure safe usage. 

Inform your healthcare provider if you are using any other substances that induce drowsiness, including but not limited to: 

• Alcohol 
• Cannabis 
• Antihistamines (such as cetirizine, diphenhydramine) 
• Sleep or anxiety medications (such as alprazolam, diazepam, and zolpidem) 
• Muscle relaxants 
• Opioid pain relievers (such as codeine) 

Grapefruit products should be avoided due to potential interactions with Orap that may cause undesirable side effects. 

Orap can cause drowsiness and impact cognitive and motor abilities, particularly during initial treatment. Refrain from driving or using machinery until the effects of this medication are understood. 

In case of vomiting or diarrhea, contact your physician promptly, as an electrolyte imbalance may arise, leading to potential heart rhythm complications during Orap intake. 

The use of Orap may lead to QT prolongation, which can result in infrequent but severe cardiac arrhythmia (including potentially fatal fast irregular heartbeat) and other symptoms (e.g., severe dizziness, fainting) requiring immediate medical attention. 

Before undergoing surgery or imaging procedures involving contrast dye (such as metrizamide), inform your doctor or dentist about your current Orap medication. 

Inform your physician of your pregnancy status, particularly during the final trimester. Notify your physician if you conceive while using Orap, as it may lead to complications in newborns when taken in the last months of pregnancy. 

Consult with your doctor before breastfeeding when taking this medication, as it is uncertain if pimozide is present in breast milk.