Pimavanserin (Oral)

Pimavanserin is used for the treatment of Parkinson's disease to tackle the psychotic side effects that the condition can cause.

Overview

In the US, pimavanserin is known by the brand name, Nuplazid. This medication is only available through your doctor with a prescription and comes in tablet form.

Pimavanserin is one of a group of drugs called atypical antipsychotics. Parkinson's disease can cause delusions and hallucinations in some patients, and this medication is very effective in preventing and treating these issues. However, it should be noted that pimavanserin is not a cure for Parkinson's disease. In addition, the medicine is not effective in treating behavioral problems in geriatric patients who have dementia or Alzheimer's disease.

This medication cannot cure Parkinson's disease, but it can be effective in tackling some of the symptoms when used as part of an overall treatment therapy for the condition.

Conditions treated

  • Hallucinations and delusions in Parkinson's disease sufferers

Type of medicine

  • Atypical antipsychotic

Side effects

In addition to its desired effects, pimavanserin can cause a few unwanted side effects. Not all patients experience any or all of these effects, but if you do notice anything odd, you may need to seek further medical attention.

If you suffer any of the following effects, you must check with your GP right away:

  • Shortness of breath
  • Irregular or slow heart rate
  • Fainting
  • Chest pain or discomfort

There are a number of side effects that may be caused by pimavanserin that do not generally require medical intervention. These effects usually go away as your body gets used to the new drug. However, if you find that any of the effects listed below are persistent or very annoying, you must check with your treating physician as a matter of urgency:

  • Unusual weight loss or gain
  • Swelling or bloating of your feet, lower legs, face, hands, arms, or feet
  • Rapid weight gain
  • Nausea
  • Constipation
  • Confusion
  • Clumsiness or unsteadiness
  • Change in walking and balance

The side effects mentioned here are not necessarily the only ones that have been experienced by people using this medicine. If you do suffer from any other effects, you should have a chat with your GP.

Dosage

You must take your prescription of pimavanserin exactly as instructed by your GP. Do not take more or less than prescribed, do not use it for a longer period or more often than you have been told to.

Do not suddenly stop taking this drug unless you have been told to by your doctor. You should take your tablet at the same time each day if possible. This helps to keep the level of the drug stable in your body, making its effect more constant.

You may take your tablet with food if you want to or just with a glass of water if you prefer.

The dose of pimavanserin that you are prescribed will not necessarily be the same for every patient. You should take your medication in accordance with your doctor's instructions or as per the directions on the dispensary label. The information that follows is solely based on the average for this drug. If your dose is different, you must not alter it unless you are told to do so by your GP.

Your daily dose of pimavanserin will be dependent on the strength of the tablets. The number of daily doses, their frequency, and the total duration of your course of treatment will depend on how your body responds to the drug, and also on your medical condition.

For the treatment of delusions and hallucinations:

  • Adults: Take two tablets (34 mg) once daily.
  • Children: Your child's GP will advise you on use and dose.

If you forget to take your daily dose of pimavanserin, try to take it immediately. However, if your next dose is due, leave out the one you forgot to take and revert to your usual schedule. Do not take twice the amount.

In the event that you or someone else in your household overdoses on pimavanserin, they may have trouble breathing or lose consciousness. In this case, you must call 911 immediately.

Never share your medication with anyone else.

If you think that your condition is getting worse or showing no signs of improvement, you should check with your GP.

Interactions

There are some medications that must never be used together, as doing so could cause a serious interaction. However, in some cases it may be appropriate to the patient's treatment program to use two or more drugs at the same time. In this case, your GP will possibly adjust the dose of or frequency of use of one or both of the drugs that you are taking.

Be sure to tell your GP about any other medication that you are using. You must also mention any side effects that you have suffered while taking pimavanserin or any other prescription or over the counter product, including herbal preparations and vitamins.

It is not recommended to use pimavanserin while you are taking any of the following medicines. Your GP may decide against treating you with pimavanserin or may change some of your other drugs:

  • Ziprasidone
  • Thioridazine
  • Terfenadine
  • Sparfloxacin
  • Saquinavir
  • Piperaquine
  • Pimozide
  • Mesoridazine
  • Ketoconazole
  • Fluconazole
  • Dronedarone
  • Cisapride
  • Bromopride
  • Bepridil
  • Amisulpride
  • Amifampridine

It is not generally recommended to take pimavanserin with any of the following drugs, but this may be necessary for some patients. If both drugs are to be used together, your GP might change your dose or frequency of use of one or both:

  • Vorinostat
  • Voriconazole
  • Vinflunine
  • Vilanterol
  • Venlafaxine
  • Vemurafenib
  • Vardenafil
  • Vandetanib
  • Triptorelin
  • Trimipramine
  • Trazodone
  • Tramadol
  • Toremifene
  • Tolterodine
  • Tizanidine
  • Tetrabenazine
  • Telithromycin
  • Telavancin
  • Telaprevir
  • Tapentadol
  • Tamoxifen
  • Tacrolimus
  • Sunitinib
  • Sulpiride
  • Sufentanil
  • Sotalol
  • Sorafenib
  • Solifenacin
  • Sodium Phosphate, Monobasic
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate
  • Sevoflurane
  • Sertindole
  • Ritonavir
  • Risperidone
  • Remifentanil
  • Ranolazine
  • Quinine
  • Quinidine
  • Quetiapine
  • Protriptyline
  • Propafenone
  • Promethazine
  • Prochlorperazine
  • Procainamide
  • Probucol
  • Pitolisant
  • Pipamperone
  • Perphenazine
  • Perflutren Lipid Microsphere
  • Pentazocine
  • Pentamidine
  • Pazopanib
  • Pasireotide
  • Paroxetine
  • Papaverine
  • Panobinostat
  • Paliperidone
  • Oxymorphone
  • Oxycodone
  • Ondansetron
  • Olanzapine
  • Ofloxacin
  • Octreotide
  • Norfloxacin
  • Nilotinib
  • Nelfinavir
  • Nefazodone
  • Nafarelin
  • Moxifloxacin
  • Morphine Sulfate Liposome
  • Morphine
  • Moricizine
  • Mizolastine
  • Mifepristone
  • Metronidazole
  • Methotrimeprazine
  • Methadone
  • Meperidine
  • Mefloquine
  • Lumefantrine
  • Lopinavir
  • Levofloxacin
  • Leuprolide
  • Lapatinib
  • Ivabradine
  • Itraconazole
  • Indinavir
  • Imipramine
  • Iloperidone
  • Idelalisib
  • Ibutilide
  • Hydroxyzine
  • Hydroxychloroquine
  • Hydroquinidine
  • Hydromorphone
  • Hydrocodone
  • Histrelin
  • Haloperidol
  • Halofantrine
  • Granisetron
  • Goserelin
  • Gonadorelin
  • Gemifloxacin
  • Gatifloxacin
  • Galantamine
  • Fosphenytoin
  • Foscarnet
  • Formoterol
  • Fluoxetine
  • Flecainide
  • Fingolimod
  • Fentanyl
  • Felbamate
  • Famotidine
  • Escitalopram
  • Erythromycin
  • Eribulin
  • Efavirenz
  • Ebastine
  • Droperidol
  • Doxepin
  • Donepezil
  • Domperidone
  • Dolasetron
  • Dofetilide
  • Disopyramide
  • Dihydrocodeine
  • Deslorelin
  • Desipramine
  • Delamanid
  • Degarelix
  • Dasatinib
  • Dabrafenib
  • Cyclobenzaprine
  • Crizotinib
  • Conivaptan
  • Codeine
  • Cobicistat
  • Clozapine
  • Clomipramine
  • Clarithromycin
  • Citalopram
  • Ciprofloxacin
  • Chlorpromazine
  • Chloroquine
  • Butorphanol
  • Buserelin
  • Buprenorphine
  • Boceprevir
  • Bedaquiline
  • Azithromycin
  • Atazanavir
  • Astemizole
  • Asenapine
  • Arsenic Trioxide
  • Aripiprazole
  • Apomorphine
  • Anagrelide
  • Amitriptyline
  • Amiodarone
  • Alfuzosin
  • Alfentanil

You should not use some drugs while you are eating or eating certain food groups, as this could cause an interaction. Alcohol or tobacco can sometimes also cause interactions to occur with some medications. Discuss this aspect of your treatment program with your GP before you start using pimavanserin.

Medical interactions

Some pre-existing medical problems can affect how this drug works. You should discuss your medical history in full with your GP before you begin taking pimavanserin.

If you suffer from any of the conditions listed below, you should use pimavanserin carefully as it could make these conditions worse:

  • QT prolongation (abnormal heart rhythm)
  • Heart rhythm problems
  • Bradycardia (slow heart beat)
  • Arrhythmia (abnormal heart beat)

Warnings

Before you start using any medication, you should discuss the risks and benefits of doing so with your GP so that you can make an informed decision. Throughout the course of your treatment you must see your doctor regularly for updates and to discuss any side effects that you have noticed.

You must mention to your GP any allergies that you have to any form of medication. You should also discuss any bad or unusual reactions that you have noted to particular food groups, animal derivatives, food dyes, or preservatives.

Medical complications

Pimavanserin can sometimes cause a condition called QT prolongation, which affects the heart's ability to maintain a correct rhythm. In rare cases, QT prolongation can cause very serious symptoms, including a very fast and irregular heartbeat, dizziness, and fainting. If you are affected in this way, seek medical attention urgently. QT prolongation can cause heart failure in some patients. Tell your GP if you or any close family members have any history of heart conditions.

If the levels of potassium or magnesium in your blood fall too low, you may also be at risk of developing QT prolongation. Drugs such as water pills can make this risk higher, as can conditions including severe sweating, vomiting, and diarrhea.

If you are due to have surgery, including dental surgery, you must tell your treating physician or dentist that you are taking pimavanserin.

Geriatric

Elderly patients may show more sensitivity to pimavanserin, especially QT prolongation.

Pregnancy and breastfeeding

Pimavanserin can present a very small risk to the unborn baby. If you are pregnant, you should only use this medication when it is clearly needed. Your GP should discuss the benefits and risks of using this medication with you.

It has not been established whether this drug passes into breast milk. However, if you are breastfeeding, you should talk to your doctor or midwife. It may be wise to use another feeding method for your infant until you have finished using this drug.

If you feel faint or dizzy, or if you notice that your heartbeat is rapid, pounding, or uneven, you should check with your doctor. Be sure to tell your GP if you or anyone in your family has ever suffered from heart rhythm problems, including QT prolongation.

Storage

You must keep your prescription of pimavanserin in a sealed container, away from moisture, direct sunlight, and heat sources. Do not freeze the medicine.

Keep the tablets where children or pets cannot reach them.

Do not retain any pimavanserin that has become out of date or that you no longer need. Ask your GP or pharmacist for advice on how to dispose of unwanted drugs.

Summary

Pimavanserin is an atypical antipsychotic that is used to treat the delusions and hallucinations that are sometimes suffered by Parkinson's disease patients. This medication cannot cure your Parkinson's, but it will help to control these unpleasant symptoms.

There are quite a few drugs that should not be used with this medication. In addition, some medical conditions, especially heart rhythm problems can be made worse by pimavanserin. You must attend regular check-ups with your GP throughout the course of your treatment with this drug.