Pimavanserin (US brand name Nuplazid®) is an atypical antipsychotic. Here is basic information about this medication.
Treatment of hallucinations and delusions associated with Parkinson’s disease psychosis
Pimavanserin is metabolized mainly by CYP3A4/3A5.
It has an active metabolite that has a half-life of more than 200 hours.
It is also a reversible inhibitor of CYP3A4.
We can start directly, without titration, at the full dose of 34 mg by mouth once daily. This is taken as two tablets of 17 mg each.
Note: I was initially confused because the clinical trials used 40 mg/day but the Prescribing Information says the dose is 34 mg/day. Then I found out what the reason is. In the clinical trials, the dose was based on pimavanserin tartrate and 20 mg of the tartrate salt is equivalent to 17 mg of pimavanserin. So the 40 mg/day dose used in clinical trials is the same as the 34 mg/day dose recommended in the Prescribing Information.
Since pimavanserin is used for psychosis associated with Parkinson’s disease, the patient is likely to be on the carbidopa/levodopa combination. Will the two medications interact with each other? No. According to the Prescribing Information, no dose adjustment is needed when pimavanserin is given along with carbidopa/levodopa.
Use in special populations
Safety and efficacy has not been established in pediatric patients.
No dosage adjustment is needed for mild to moderate renal impairment and elderly patients.
Not recommended in severe renal impairment or with hepatic impairment as safety and efficacy has not been established in these patient populations.
Dosage forms and strengths
Nuplazid® is available in only one strength: as tablets of 17 mg each.
Cost and availability
The other issue is that, as of June 2017, pimavanserin is only available through “specialty pharmacies”.
To address both these problems, the manufacturer has a program called NUPLAZIDConnect, which is supposed to help patients with getting insurance approval and in obtaining the medication through the specialty pharmacy.
Important: Please refer to Prescribing Information (see link below) for a complete discussion of dosage, administration, warnings and precautions, contraindications, etc.
Bozymski KM, Lowe DK, Pasternak KM, Gatesman TL, Crouse EL. Pimavanserin: A Novel Antipsychotic for Parkinson’s Disease Psychosis. Ann Pharmacother. 2017 Jun;51(6):479-487. PubMed PMID: 28375643.
Copyright 2017, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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