Home Drug Guide Pimavanserin Tartrate

Drug Guide

Generic Name

Pimavanserin Tartrate

Brand Names Nuplazid

Classification

Therapeutic: Antipsychotic, central nervous system

Pharmacological: Selective 5-HT2A receptor inverse agonist

FDA Approved Indications

  • Parkinson's disease psychosis

Mechanism of Action

Pimavanserin selectively targets 5-HT2A receptors as an inverse agonist, modulating serotonin activity implicated in psychosis without affecting dopaminergic receptors, thereby reducing hallucinations and delusions in Parkinson's disease psychosis.

Dosage and Administration

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

Pediatric: Not approved for pediatric use.

Geriatric: Similar dosing as adults, but caution in elderly with hepatic impairment.

Renal Impairment: Use caution; no specific dosage adjustments established.

Hepatic Impairment: No specific recommendations, but monitor closely due to hepatic metabolism.

Pharmacokinetics

Absorption: Rapid absorption, peak plasma concentration in about 2 hours.

Distribution: Widely distributed; high plasma protein binding.

Metabolism: Metabolized primarily via CYP3A4; minimal CYP2D6 involvement.

Excretion: Excreted mainly in feces; minimal urinary excretion.

Half Life: Approximately 57 hours, allowing for once-daily dosing.

Contraindications

  • Hypersensitivity to pimavanserin or any component of the formulation.

Precautions

  • Use with caution in patients with QT prolongation, history of seizures, or those taking other QT-prolonging drugs. Monitor for falls and cognitive impairment, especially in elderly.

Adverse Reactions - Common

  • ∑Headache (Common)
  • Confusion (Common)
  • Peripheral edema (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • QT prolongation, resulting in risk of torsades de pointes (Serious, requires monitoring)
  • Falls, leading to injury (Serious)
  • Psychosis or worsening of symptoms (Serious)

Drug-Drug Interactions

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

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor patient's mental status, for hallucinations, delusions, and behavioral changes. ECG monitoring for QT interval if indicated.

Diagnoses:

  • Risk for falls due to sedation or hypotension.
  • Risk for electrolyte imbalances affecting QT interval.

Implementation: Administer as prescribed. Monitor for adverse reactions, especially QT prolongation.

Evaluation: Assess for improvement in psychosis symptoms and monitor for adverse effects.

Patient/Family Teaching

  • Do not operate heavy machinery until accustomed to effects.
  • Report any side effects such as prolonged QT interval, fainting, or worsening hallucinations.
  • Follow prescribed dosing schedule.
  • Avoid abrupt discontinuation.

Special Considerations

Black Box Warnings:

  • QT prolongation and potential for arrhythmias.
  • Use with caution in elderly patients due to increased risk of death (generally included in antipsychotics).

Genetic Factors: CYP3A4 polymorphisms may affect drug levels.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Dizziness, hypotension, sleepiness, seizures, or prolonged QT interval.

Treatment: Supportive care, ECG monitoring, and management of symptoms. Activated charcoal if ingestion was recent. No specific antidote.

Storage and Handling

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

Stability: Stable until the expiration date on the package.

🛡️ 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.