Home Drug Guide Pimavanserin

Drug Guide

Generic Name

Pimavanserin

Brand Names Nuplazid

Classification

Therapeutic: Psychotropic agent / Antipsychotic

Pharmacological: Selective serotonergic 5-HT2A receptor inverse agonist

FDA Approved Indications

  • Parkinson's disease psychosis

Mechanism of Action

Pimavanserin selectively modulates serotonin 5-HT2A receptors as an inverse agonist, which helps reduce hallucinations and delusions associated with psychosis in Parkinson's disease patients without affecting dopamine receptors.

Dosage and Administration

Adult: 34 mg once daily, can be taken with or without food.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dose adjustment, but monitor elderly patients carefully due to potential increased sensitivity to side effects.

Renal Impairment: Adjust dose cautiously; no specific guidelines established.

Hepatic Impairment: Use with caution; no specific dose adjustments recommended.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, with a high affinity for brain tissue.

Metabolism: Primarily metabolized by CYP3A4 and CYP1A2 enzymes.

Excretion: Excreted mainly via feces, minimal renal excretion.

Half Life: Approximately 55 hours.

Contraindications

  • Concomitant use with other serotonergic drugs due to serotonin syndrome risk.
  • Hypersensitivity to Pimavanserin.

Precautions

  • Use cautiously in patients with QT prolongation, history of seizures, or who are taking other QT prolonging drugs.
  • Monitor mental status as there may be an increased risk of suicidality.

Adverse Reactions - Common

  • Falls, nausea, confusion, hallucinations (Common)
  • Peripheral edema, constipation (Common)

Adverse Reactions - Serious

  • QT prolongation, leading to serious arrhythmias (Serious (rare))
  • Suicidality, worsening psychosis (Serious)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) can increase Pimavanserin levels.
  • CYP3A4 inducers (e.g., rifampin, carbamazepine) can decrease levels.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for changes in mental status, hallucinations, and suicidality. ECG monitoring for QT prolongation.

Diagnoses:

  • Risk for falls related to dizziness or imbalance.
  • Risk for injury due to altered mental status.
  • Potential for serotonin syndrome.

Implementation: Administer as prescribed. Monitor ECG periodically. Educate patient on signs of serotonin syndrome and adverse effects.

Evaluation: Assess symptom improvement and side effects regularly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any new or worsening hallucinations, confusion, or suicidality.
  • Avoid other serotonergic drugs unless approved by provider.
  • Report symptoms of dizziness or fainting.

Special Considerations

Black Box Warnings:

  • Serious adverse reactions including QT prolongation, ventricular arrhythmias, and sudden death. Increased risk of death in elderly patients with dementia-related psychosis.

Genetic Factors: No specific genetic considerations noted.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Severe hypotension, QT prolongation, arrhythmias, CNS depression.

Treatment: Supportive care; monitor cardiac rhythm; activated charcoal if ingestion recent; no specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.