Pronunciation: nu-plaz-id
Generic name: pimavanserin
Dosage form: oral capsule, oral tablet
Drug class: Atypical antipsychotics

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 8, 2024.

What is Nuplazid?

Nuplazid (pimavanserin) is an antipsychotic medicine that may be used to treat hallucinations and delusions in people with psychosis related to Parkinson's disease (PD).

• Nuplazid should not be used to treat people with dementia-related psychosis.

The way Nuplazid works to relieve hallucinations and delusions is not well understood but it has been shown to have activity at various serotonin receptors in the brain, which may explain its mechanism of action. More than 50% of people with PD experience psychotic symptoms and clinical studies have shown Nuplazid significantly reduces the frequency and/or severity of hallucinations, with effects being noticed within 2 weeks and improving throughout the six-week trial period.

Nuplazid gained FDA approval on April 29, 2016. Nuplazid belongs to the drug class called atypical antipsychotics.

Nuplazid side effects

Common Nuplazid side effects may include:

• confusion

• swelling in your hands or feet (peripheral edema).

Serious side effects and warnings

Nuplazid carries a Boxed Warning for increased mortality in elderly patients with dementia-related psychosis.

Elderly patients with dementia-related psychosis treated with antipsychotic drugs, such as Nuplazid, are at an increased risk of death. Nuplazid is not approved for the treatment of patients with dementia who experience

psychosis unless their hallucinations and delusions are related to Parkinson’s disease.

Nuplazid can also affect the heart's electrical system and cause QT prolongation. Tell your healthcare provider about all the medications you take because Nuplazid should not be taken with other medications that affect the QT interval (see "What drugs will affect Nuplazid" below). Some people are at a higher risk of QT prolongation. Call your doctor at once if you have:

• fast or pounding heartbeats, fluttering in your chest;

• shortness of breath; or

• sudden dizziness (like you might pass out).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Related/similar drugs

Before taking

Do not take Nuplazid if you are allergic to pimavanserin, Nuplazid, or any inactive ingredients in the capsules or tablets. Get emergency medical help if you have signs of an allergic reaction to Nuplazid which may include hives; difficulty breathing; or swelling of your face, lips, tongue, or throat.

Tell your doctor about all your medical conditions including if you have ever had:

• a heart rhythm disorder

• long QT syndrome (in you or a family member)

• kidney disease

• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood)

• are pregnant or intend to become pregnant

• are breastfeeding.

Pregnancy

It is not known whether Nuplazid will harm an unborn baby.

Breastfeeding

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risks.

How should I take Nuplazid?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

• Nuplazid is usually taken once daily.
• You may take Nuplazid with or without food.

If you cannot swallow a capsule whole, open it and sprinkle the medicine into a spoonful of pudding, applesauce, yogurt, or a nutrition drink. Swallow the mixture right away without chewing. Do not save it for later use.

When you start or stop taking other medicines, your doctor may need to adjust your Nuplazid dose. Tell your healthcare provider about all the medicines you take.

Nuplazid Dosing information

The usual adult dose of Nuplazid for PD-related psychosis is 34 mg orally once a day.

• Can be taken as one Nuplazid 34 mg capsule.

A dosage reduction may be needed in people who also take strong CYP3A4 Inhibitors, such as clarithromycin, erythromycin, diltiazem, itraconazole, ketoconazole, ritonavir, verapamil, goldenseal, and grapefruit.

• The dosage of Nuplazid in these people should be reduced to Nuplazid 10 mg once a day.

Nuplazid should not be taken by people who also take strong or moderate CYP3A4 inducers, such as phenobarbital, phenytoin, rifampicin, St. John's Wort, and glucocorticoids.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

A Nuplazid overdose may cause nausea and vomiting.

What to avoid while taking Nuplazid

Avoid drinking alcohol. Dangerous side effects could occur.

Do not take over-the-counter supplements or herbal remedies without first checking with your healthcare provider or pharmacist if they are safe to take with Nuplazid.

What other drugs will affect Nuplazid?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Your dose of Nuplazid may need to be adjusted if you use certain other medications. It is very important to tell your doctor if you start or stop using any other medications. Especially tell your healthcare provider if you take:

• Strong CYP3A4 Inhibitors, such as clarithromycin, erythromycin, diltiazem, itraconazole, ketoconazole, ritonavir, verapamil, goldenseal, or grapefruit
• Strong or moderate CYP3A4 inducers, such as phenobarbital, phenytoin, rifampicin, St. John's Wort, or glucocorticoids.

Nuplazid can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Many drugs can interact with pimavanserin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Nuplazid storage

Store at room temperature away from moisture and heat.

Nuplazid ingredients

Nuplazid capsules 34 mg

Active ingredients: pimavanserin tartrate 40 mg which is equivalent to 34 mg of pimavanserin free-base.

Inactive ingredients: magnesium stearate and microcrystalline cellulose. Additionally, the following inactive ingredients are present as components of the capsule shell: black iron oxide, FD&C blue #1, hypromellose, titanium dioxide, and yellow iron oxide.

Nuplazid tablets 10 mg

Active ingredients: pimavanserin tartrate 11.8 mg which is equivalent to 10 mg pimavanserin free-base.

Inactive ingredients: magnesium stearate, pregelatinized starch, and silicified microcrystalline cellulose.
Additionally, the following inactive ingredients are present as components of the film coat: polyethylene
glycol, polyvinyl alcohol, red iron oxide, talc, titanium dioxide, and yellow iron oxide.

Who makes Nuplazid?

Acadia Pharmaceuticals Inc. manufactures Nuplazid.

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Further information

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