pimavanserin

Antipsychotic • Brands: Nuplazid

Last reviewed: 2026-02-22

General information

Class: Antipsychotic
Common US brands: Nuplazid
Typical dose range: Recommended dose is 34 mg once daily without titration (label).
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2026-02-22

Dosing & forms

Forms/strengths: Oral capsule (label): 34 mg.; Oral tablet (label): 10 mg.
Frequency: Recommended dose is 34 mg once daily without titration (label).
Typical range: Recommended dose is 34 mg once daily without titration (label).

Mechanism (brief)

Selective serotonin 5-HT2A inverse agonist/antagonist with minimal dopamine receptor activity. Approved for hallucinations and delusions associated with Parkinson’s disease psychosis (label).

Metabolism & Half‑life

Metabolism: CYP3A4, CYP3A5, CYP2J2 (minor), CYP2D6 (minor)
Half‑life: Single-dose mean 57 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Review baseline QT risk (history of arrhythmia/syncope, electrolyte abnormalities) and other QT-prolonging drugs; consider an ECG when risk is elevated (label/clinical).
Monitor for confusional state/delirium, peripheral edema, and falls, especially in older adults with baseline cognitive impairment (label/clinical).
Reassess hallucinations/delusions and caregiver distress after initiation (often within the first month) and after major medication changes (clinical).
Medication reconciliation: avoid strong CYP3A4 inducers, reduce dose with strong CYP3A4 inhibitors, and re-check interactions when new medicines are started (label).
If switching from another antipsychotic, use a structured cross-taper plan and monitor for rebound psychosis or withdrawal effects (consensus/clinical).

Sources

NUPLAZID (pimavanserin tartrate) prescribing information — DailyMed (2025)
Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial — Lancet (2014)
Evidence-Based Review of Pharmacotherapy Used for Parkinson's Disease Psychosis — The Annals of Pharmacotherapy (2017)
Guidance for switching from off-label antipsychotics to pimavanserin for Parkinson's disease psychosis: an expert consensus — CNS Spectrums (2018)

Monitoring highlights

Review baseline QT risk (history of arrhythmia/syncope, electrolyte abnormalities) and other QT-prolonging drugs; consider an ECG when risk is elevated (label/clinical).

Monitor for confusional state/delirium, peripheral edema, and falls, especially in older adults with baseline cognitive impairment (label/clinical).

Reassess hallucinations/delusions and caregiver distress after initiation (often within the first month) and after major medication changes (clinical).

Medication reconciliation: avoid strong CYP3A4 inducers, reduce dose with strong CYP3A4 inhibitors, and re-check interactions when new medicines are started (label).

If switching from another antipsychotic, use a structured cross-taper plan and monitor for rebound psychosis or withdrawal effects (consensus/clinical).