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Pimozide Overdose-induced Extrapyramidal Symptoms Mimicking Neuroleptic Malignant Syndrome: A Case Report with

Kaushik Patil1, Vinayak Koparde

  • 1Department of Psychiatry, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India.

Annals of African Medicine
|July 23, 2026
PubMed

Insights

Pimozide overdose can cause severe extrapyramidal symptoms (EPS) mimicking neuroleptic malignant syndrome (NMS). Differentiating requires monitoring creatine phosphokinase (CPK) levels and fever response; supportive care is crucial.

Area of Science:

  • Pharmacology
  • Neurology
  • Toxicology

Background:

  • Pimozide overdose is rare, with a long elimination half-life causing prolonged toxicity.
  • Extrapyramidal symptoms (EPS) in overdose can mimic neuroleptic malignant syndrome (NMS).

Purpose of the Study:

  • To report a case of severe pimozide overdose.
  • To highlight the diagnostic challenges and management of pimozide-induced toxicity.

Main Methods:

  • Case report of a 33-year-old female with intentional pimozide overdose.
  • Clinical presentation, laboratory findings (CPK), and treatment response were documented.

Main Results:

  • The patient presented with rigidity, mutism, and reduced responsiveness, consistent with severe EPS.
  • Mildly elevated CPK (523 U/L) and fever aided in differentiating from NMS.
  • EPS improved with supportive care and levodopa-carbidopa, but aspiration pneumonia led to mortality.

Conclusions:

  • Pimozide overdose can induce severe EPS that closely resemble NMS.
  • Creatine phosphokinase levels and fever response are key differentiating factors.
  • Prompt supportive care and extended observation are vital for managing pimozide toxicity.
Keywords:
Drug overdosePimozideSurdosage médicamenteuxSymptômes extrapyramidauxSyndrome malin des neuroleptiquesextrapyramidal symptomsneuroleptic malignant syndromepimozide

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