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.
Hallucinations and delusions related to Parkinson's disease
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.
Source: DailyMed
Side effects that you should report to your doctor or health care professional as soon as possible:
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
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
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
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.
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.
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.
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.
The typical dose is 34 mg by mouth once a day, with or without food.
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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.
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.
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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.
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