Skip to content

pimavanserin

Antipsychotic

Brands: Nuplazid

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

View details

Quick answers

  • What is pimavanserin?

    Pimavanserin (brand Nuplazid) is an antipsychotic-class medication that treats hallucinations and delusions associated with Parkinson’s disease psychosis (PDP) (label).

  • What is Nuplazid?

    Nuplazid is a brand name for pimavanserin.

  • What is Nuplazid (pimavanserin) used for?

    Label indications include: Hallucinations and delusions associated with Parkinson’s disease psychosis (label).

  • What drug class is Nuplazid (pimavanserin)?

    Antipsychotic.

  • What is the mechanism of action of Nuplazid (pimavanserin)?

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

  • What strengths does Nuplazid (pimavanserin) come in?

    Oral capsule (label): 34 mg.

  • Is Nuplazid (pimavanserin) a controlled substance?

    No — it is not scheduled as a controlled substance under U.S. federal law.

Snapshot

  • Class: Antipsychotic
  • Common US brands: Nuplazid
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-30

Label indications

Hallucinations and delusions associated with Parkinson’s disease psychosis (label).

View labelExact

Clinical Highlights

Pimavanserin (brand Nuplazid) is an antipsychotic-class medication that treats hallucinations and delusions associated with Parkinson’s disease psychosis (PDP) (label). A key differentiator is that pimavanserin does not meaningfully block dopamine receptors. That is clinically important in Parkinson’s disease because dopamine blockade can worsen motor symptoms; pivotal trials found improvement in psychosis without worsening motor ratings versus placebo (label/trial).

Read more
  • Parkinson’s psychosis symptoms can be triggered or worsened by medical illness, medication changes, and sleep disruption. Many care plans address reversible contributors in parallel rather than relying on medication alone (clinical).
  • Pimavanserin carries the antipsychotic class boxed warning about increased mortality in elderly patients with dementia-related psychosis. It is not approved for dementia-related psychosis unless hallucinations and delusions are related to Parkinson’s disease (label).
  • QT prolongation risk is an important safety consideration; clinicians often review baseline QT risk factors and other QT-prolonging drugs before starting (label/clinical).
  • The compare view, pimavanserin evidence feed, and pimavanserin print page support counseling when Parkinson’s psychosis treatment choices overlap with sedation, orthostasis, or QT concerns.

Dosing & Formulations

Recommended dose is 34 mg orally once daily without titration (label). Formulations (label): 34 mg capsules; 10 mg tablets (used for dose adjustment when co-administered with strong CYP3A4 inhibitors).

Read more
  • Strong CYP3A4 inhibitors require a reduced dose (10 mg once daily); strong or moderate CYP3A4 inducers are generally avoided because they reduce exposure (label).

Monitoring & Risks

Boxed warning: increased mortality in elderly patients with dementia-related psychosis treated with antipsychotics; Nuplazid is not approved for dementia-related psychosis unless related to Parkinson’s disease (label). QT prolongation: ECG planning is often considered when baseline risk is elevated or when patients take other QT-prolonging drugs (label/clinical).

Read more
  • Common adverse reactions in PDP trials include peripheral edema and confusional state; clinicians often monitor for falls, delirium, and functional decline in older adults (label/clinical).

Drug Interactions

CYP3A4 modulators matter: strong inhibitors increase exposure and require dose reduction; inducers can markedly decrease exposure and are generally avoided (label). Avoid combining with other QT-prolonging drugs when possible, and reassess risk if combination is unavoidable (clinical).

Practice Notes

In Parkinson’s disease psychosis, non-pharmacologic contributors (infection, medication changes, sleep disruption) are often addressed in parallel with antipsychotic selection (clinical). Expert consensus publications describe switching approaches from off-label antipsychotics to pimavanserin when motor worsening or sedation is a concern (consensus).

Read more
  • Compared with off-label options like low-dose quetiapine or clozapine, pimavanserin is the only FDA-approved option for Parkinson’s disease psychosis in the U.S. Selection commonly weighs sedation/cognitive effects, fall risk, and QT considerations (label/clinical).

References

  1. NUPLAZID (pimavanserin tartrate) prescribing information — DailyMed (2025)
  2. Pimavanserin FOR Patients With Parkinson's Disease Psychosis: A Randomised, Placebo Controlled Phase 3 Trial — Lancet (2014)
  3. Evidence Based Review OF Pharmacotherapy Used FOR Parkinson's Disease Psychosis — The Annals of Pharmacotherapy (2017)
  4. Guidance FOR Switching From OFF Label Antipsychotics TO Pimavanserin FOR Parkinson's Disease Psychosis: AN Expert Consensus — CNS Spectrums (2018)
Pimavanserin (Nuplazid) — Summary — PsychMed