Parkinson’s Disease: A disorder of the central nervous system that affects movement, often including tremors. Approximately 1 million people in the US live with Parkinson’s disease (PD). More than 50% will develop Parkinson Disease Psychosis (PDP) during the course of their disease. Hallucinations associated with PD is the strongest independent predictor of nursing home placement.
Nuplazid is an atypical antipsychotic and is the only FDA-approved medication for the treatment of hallucinations and delusions associated with Parkinson’s Disease Psychosis.
Mechanism of Action
The effect of pimavanserin could be mediated through a combination of inverse agonist and antagonist activity at serotonin 5-HT2A receptors and to a lesser extent at serotonin 5-HT2C receptor.
The recommended dose of Nuplazid is 34 mg taken orally once daily, without titration. Nuplazid can be taken with or without food. Nuplazid capsules can be taken whole or opened and the entire contents sprinkled over a tablespoon (15 mL) of applesauce, yogurt, pudding, or a liquid nutritional supplement. Consume the drug/food mixture immediately without chewing; do not store for future use. No dose adjustment is required for elderly patients except in patients with ESRD or severe renal impairment (CrCl < 30ml/min). The recommended dose of Nuplazid when co-administered with strong CYP3A4 inhibitors (e.g., ketoconozole) is 10 mg, taken orally as one tablet once daily.
Strong CYP3A4 Inhibitors: Itraconazole, Ketoconazole, Clarithromycin and Indinavir. Strong or Moderate CYP3A4 Inducers: Carbamazepine, Phenytoin, St. Johns Wart, Rifampin, Modafinil, Thioridazine, Nafcillin and Efavirenz. QT Interval Prolongation: quinidine, procainamide, disopyramide, Amiodarone, Sotalol, Ziprasidone, Chlorpromazine, Thioridazine, Gatifloxacin, Moxifloxacin.
Increased Mortality in elderly patients with Dementia-Related Psychosis. Nuplazid should also be avoided in patients with a history of cardiac arrhythmias, as well as other circumstances that may increase the risk of the occurrence of torsade de pointes.
Most common adverse reaction with Nuplazid are confusion, constipation, hallucinations, peripheral edema, nausea and stroke.
10mg tablet and 34mg capsule
Gradual dose Reduction and Nuplazid: CMS – The time frames and duration of attempts to taper any medication must be consistent with accepted standards of practice and depend on factors including the coexisting medication regimen, the underlying causes of symptoms, individual risk factors, and pharmacologic characteristics of the medications. Some medications (e.g., antidepressants, sedative/hypnotics, opioids) require more gradual tapering so as to minimize or prevent withdrawal symptoms or other adverse consequences. Close monitoring while medications are tapered will enable facility staff to determine whether a resident is experiencing side effects, changes in behavior, or withdrawal symptoms that originally prompted prescribing of the drug. However, some residents with specific, enduring, progressive, or terminal conditions such as chronic depression, Parkinson’s disease psychosis, or recurrent seizures may need specific types of psychotropic medications or other medications which affect brain activity indefinitely.