MPA | Pharmacy News

by Allison Simsa, Pharm.D. Candidate

Parkinson’s disease is an insidious and progressive neurologic disease primarily occurring in the older population. It is characterized by bradykinesia, muscular rigidity, tremor at rest, and postural instability.1 In later stages of the disease, patients have greatly restricted mobility and impairment in the ability to continue with activities of everyday life. While Parkinson’s is mainly considered a movement disorder, neuropsychiatric abnormalities often develop, presenting similar to those seen with dementia.1 In April 2016, pimavanserin (Nuplazid™) was FDA-approved for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.2,3 In clinical trials, pimavanserin was only compared to placebo and found to be superior. Pimavanserin is available as 17mg tablets, which patients are to take two of (to total 34mg) once daily without regard to food. This drug carries a black box warning for increased mortality in elderly patients with dementia-related psychosis. Pimavanserin is not approved for and should not be used in patients with dementia-related psychosis unrelated to Parkinson’s disease psychosis. In addition, pimavanserin increases the QT interval and should not be used with drugs that also increase the QT interval or in patients already at a high risk for QT prolongation. Commonly occurring side effects reported during clinical trials were peripheral edema and confusional state.

References:

  1. Chen, Jack J., and David M. Swope. "Chapter 43. Parkinson’s Disease." Pharmacotherapy: A Pathophysiologic Approach, 9e. Eds. Joseph T. DiPiro, et al. New York, NY: McGraw-Hill, 2014
  2. Nuplazid™ [prescribing information], San Diego, CA: Acadia Pharmaceuticals, 2016.
  3. CenterWatch. Nuplazid (pimavanserin). 2016.

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