Nuplazid
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.
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 Brands | Nuplazid |
|---|---|
| Drug Class | Atypical antipsychotic |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
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%)
Less Common Side Effects
- Abnormal walking
- Sleepiness
- Falls
- Rash
- Hives
- Agitation or distress
- Aggression
Nuplazid (pimavanserin) 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
The following Nuplazid (pimavanserin) 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.
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
Typical dosage for Nuplazid (pimavanserin)
The typical dose is 34 mg by mouth once a day, with or without food.
Nuplazid (pimavanserin) images
