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
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.
Common questions about Nuplazid (pimavanserin)
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.
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).
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.
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).
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.
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.
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.
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.
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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
