Are you a healthcare professional? Join GoodRx for HCPs

Nuplazid

pimavanserin

Used for Parkinson's Disease

Nuplazid (pimavanserin) is used to treat hallucinations and delusions in adults with Parkinson’s disease. This medication belongs to a drug class called atypical antipsychotics. Nuplazid (pimavanserin) is available as tablets and capsules that are taken by mouth with once-daily dosing. Side effects can include nausea, swelling in the legs or feet, and confusion. Nuplazid (pimavanserin) is a brand-name medication; there's no generic version available at this time.

Reviewed by:

Daisy Chau, PharmD

Cydnee Ng, PharmD

Last reviewed on December 11, 2023

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Images References Prices Medicare

What is Nuplazid (pimavanserin)?

What is Nuplazid (pimavanserin) used for?

Hallucinations and delusions related to Parkinson's disease

How Nuplazid (pimavanserin) works

Nuplazid (pimavanserin) is an atypical antipsychotic. It's not completely clear how this medication works to treat Parkinson's disease-related hallucinations and delusions (seeing, hearing, or believing things that aren't real).

Nuplazid (pimavanserin) is thought to work on serotonin receptors in the brain. This might help regulate levels of a chemical called serotonin in the brain, which might help control your thoughts and behavior.

Drug Facts

Common BrandsNuplazid

Drug ClassAtypical antipsychotic

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

What are the side effects of Nuplazid (pimavanserin)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Swelling in the arms, legs, or feet (7%)
Nausea (7%)
Confusion (6%)
Hallucination (5%)
Constipation (4%)

Other Side Effects

Abnormal walking
Sleepiness
Falls
Rash
Hives
Agitation or distress
Aggression

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

Abnormal heart rhythm: racing or pounding heart, feeling faint or dizzy
Angioedema: swelling of your face, lips, tongue, or throat; trouble breathing

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your doctor or health care professional as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

Confusion
Constipation
Drowsiness
Fatigue
Nausea
Swelling of the ankles, hands, or feet

Pros and cons of Nuplazid (pimavanserin)

Pros

Doesn't interact with carbidopa/levodopa medications, so no need for dose adjustments

Doesn't worsen or cause new movement problems, tardive dykinesia)

Available as a capsule that you can open and sprinkle onto soft foods if you have trouble swallowing

Cons

Might cause nausea and confusion as a side effect

Has risk of abnormal heart rhythms that can be dangerous

Has many interactions with other medications, such as certain antipsychotics, antiseizure medications, and antibiotics

Pharmacist tips for Nuplazid (pimavanserin)

You can take Nuplazid (pimavanserin) with or without food.

Ask your provider about switching to the Nuplazid (pimavanserin) capsules if you have trouble swallowing. You can swallow the capsules whole, or you can open the capsules and sprinkle the contents onto a small amount of soft food, such as yogurt or applesauce. Swallow the mixture right after sprinkling it on the food without chewing.

Before you start any new medications, let your providers and pharmacists know that you're taking Nuplazid (pimavanserin). They can make sure all your medications are safe to take together. Some medications can interact with Nuplazid (pimavanserin) and affect how well it works or raise your risk for side effects. Examples include amiodarone (Pacerone) and certain antipsychotics, antiseizure medications, and antibiotics like rifampin (Rifadin).

Call 911 and get emergency help right away if you feel your heart pounding or feel like you're going to faint. Nuplazid (pimavanserin) can raise the risk for dangerous changes to your heart rhythm.

Protect Nuplazid (pimavanserin) capsules from light to prevent the color from fading away.

Frequently asked questions about Nuplazid (pimavanserin)

Does Nuplazid (pimavanserin) make you sleepy?

Though not common, some people have reported feeling sleepy while they were taking Nuplazid (pimavanserin). Make sure you know how Nuplazid (pimavanserin) affects you before driving or doing anything that you need to be alert for, just in case the medication makes you sleepy.

Is Nuplazid (pimavanserin) a specialty medication?

Yes, Nuplazid (pimavanserin) is considered a specialty medication. This means that Nuplazid (pimavanserin) isn't typically available at local pharmacies, but through specific specialty pharmacies. You'll usually work with your provider and the specific pharmacy to get the medication. Sometimes, the specialty pharmacy can mail the medication directly to you. Talk to your provider or pharmacist if you have questions about which specialty pharmacy you can use to get Nuplazid (pimavanserin).

How long does Nuplazid (pimavanserin) stay in your system?

It can take 11 days to about a month for most of a single dose of Nuplazid (pimavanserin) to leave your body. This time frame is estimated based on the half-life of the medication.

Is Nuplazid (pimavanserin) an antipsychotic?

Yes, Nuplazid (pimavanserin) is an atypical antipsychotic. Antipsychotics are typically used to help treat hallucinations and delusions in certain people. But unlike most antipsychotics, Nuplazid (pimavanserin) doesn't appear to worsen Parkinson's disease-related movement problems or cause new movement problems called tardive dyskinesia (TD).

Can Nuplazid (pimavanserin) be crushed?

The manufacturer of Nuplazid (pimavanserin) doesn't state whether the tablets or capsules can be crushed. But if you're having trouble swallowing the medication, you can open the capsule and sprinkle the contents inside on top of a tablespoon of soft food (e.g., applesauce, pudding, yogurt, liquid nutritional supplement). Swallow the mixture without chewing right after you prepare it. Ask your provider about taking the Nuplazid (pimavanserin) capsules if you're having trouble swallowing pills whole.

Can Nuplazid (pimavanserin) capsules be opened?

Yes. You can open Nuplazid (pimavanserin) capsules and sprinkle the contents over a small amount of soft food, such as applesauce, pudding, or yogurt. Swallow the mixture right away without chewing. Opening the capsule to take Nuplazid (pimavanserin) is helpful if you're having trouble swallowing the Nuplazid (pimavanserin) tablets or capsules whole.

How effective is Nuplazid (pimavanserin)?

Over a 10-week long clinical study, people who took Nuplazid (pimavanserin) had noticeable improvements in their hallucination and delusional symptoms. Most people's hallucinations and delusions improved in severity during the study. Follow up with your provider to discuss how well Nuplazid (pimavanserin) is working for you.

How long does it take for Nuplazid (pimavanserin) to work?

Studies show that some people who took Nuplazid (pimavanserin) noticed improvements in hallucination and delusional symptoms in as early as 2 weeks of starting treatment. But it can take up to 6 weeks or longer to notice the full effects of the medication. Keep in mind that everyone responds to the medication differently, so continue to take Nuplazid (pimavanserin) exactly as prescribed by your healthcare provider even if you don't see noticeable improvements. Make sure to check in with your provider and discuss how well Nuplazid (pimavanserin) is working for you.

How to save using GoodRx

1. Compare PricesSpecify your dosage and quantity to find out exactly how much you can save.

2. Select your free couponYou can use the displayed coupon, or compare prices at other pharmacies near you.

3. Show coupon to your pharmacistPresent your printed or electronic coupon when you pick up your prescription.

Get free coupon Learn more

What are the risks and warnings for Nuplazid (pimavanserin)?

Nuplazid (pimavanserin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Higher risk of death in older adults with dementia-related psychosis

Risk factors: Older adults with dementia-related psychosis

People over the age of 65 who have dementia sometimes have hallucinations and delusions. This is called dementia-related psychosis, and it shouldn't be treated with Nuplazid (pimavanserin). Studies show that older adults with dementia-related psychosis who take medications like Nuplazid (pimavanserin) have a higher risk of death. In studies, causes of death were often linked to heart problems (e.g., heart failure) or infections. Tell your provider if you or your loved one has dementia before starting treatment.

Life-threatening changes in your heart rhythm (QT prolongation)

Risk factors: Irregular heart rhythm (arrhythmias) | Inherited heart rhythm abnormalities | Slow heart rate | Low potassium or magnesium levels in the blood | Taking other medications that affect your heart rhythm

Nuplazid (pimavanserin) can lengthen the time it takes for your heart to contract and relax. This is known as QT prolongation and can raise your risk for life-threatening changes in your heart rhythm.

Let your providers and pharmacists know about your medical history and all the medications you're taking. You should avoid taking Nuplazid (pimavanserin) if you already have an irregular heart rhythm (arrhythmias) or other conditions that can raise your risk for heart rhythm problems. In addition, taking certain medications with Nuplazid (pimavanserin) can put you at higher risk for QT prolongation.

Call 911 and seek medical help right away if you feel dizzy, feel like your heart is pounding, or feel like you're going to faint.

Nuplazid (pimavanserin) dosage forms

Typical dosing for Nuplazid (pimavanserin)

The typical dose is 34 mg by mouth once a day, with or without food.

Nuplazid (pimavanserin) images

This medicine is Green And White Capsule Imprinted With "Pima 34".Green And White Pima 34 - NUPLAZID 34mg Capsule

Get savings updates for Nuplazid (pimavanserin)

Receive price alerts, news, and other messages from GoodRx about Nuplazid (pimavanserin) and other healthcare topics and relevant savings offers.

By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.

References

Best studies we found

Acadia Pharmaceuticals Inc. (2023). Nuplazid- pimavanserin tartrate capsule; pimavanserin tartrate tablet, coated [package insert]. DailyMed.

Acadia Pharmaceuticals Inc. (2023). Understanding Parkinson’s disease–related hallucinations and delusions.

Acadia Pharmaceuticals Inc. (n.d.). Acadia Connect.

View All References (6)

Al-Akchar, M., et al. (2022). Long QT syndrome. StatPearls.

Cruz, M. P. (2017). Pimavanserin (Nuplazid): A treatment for hallucinations and delusions associated with Parkinson's disease. Pharmacy and Therapeutics.

Farzam, K., et al. (2023). QT prolonging drugs. StatPearls.

Isaacson, S. H., et al. (2021). Efficacy results of pimavanserin from a multi-center, open-label extension study in Parkinson's disease psychosis patients. Parkinsonism & Related Disorders.

MedlinePlus. (2022). Secondary parkinsonism.

Ward, K. M., et al. (2018). Antipsychotic-related movement disorders: Drug-induced parkinsonism vs. tardive dyskinesia-key differences in pathophysiology and clinical management. Neurology and Therapy.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

Was this page helpful?

Browse medications

View All

Research prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.