Nuplazid is a brand-name prescription medication. It’s FDA-approved to treat hallucinations and delusions related to Parkinson’s disease psychosis in adults. (With hallucinations, you see or hear things that aren’t really there. With delusions, you believe something that isn’t true, and such beliefs are often unrealistic.)

Parkinson’s disease is a condition that affects your nervous system. More common symptoms can include tremors (shaking), slow movements, and stiff muscles. Some people with Parkinson’s disease may also experience psychosis (loss of contact with reality). It’s the hallucinations or delusions caused by this psychosis that Nuplazid is used to treat.

Nuplazid contains the active drug pimavanserin. It belongs to a group of medications called atypical antipsychotics.

Nuplazid comes as a tablet or capsule that’s taken by mouth. The tablet is available in a strength of 10 milligrams (mg), and the capsule is available in a strength of 34 mg.

Effectiveness

For information on the effectiveness of Nuplazid, see the “Nuplazid uses” section below.

Nuplazid is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Nuplazid contains the active drug pimavanserin.

Nuplazid can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Nuplazid. These lists don’t include all possible side effects.

For more information on the possible side effects of Nuplazid, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Nuplazid, you can do so through MedWatch.

Mild side effects

Mild side effects of Nuplazid can include:*

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Nuplazid. To learn about other mild side effects, talk with your doctor or pharmacist, or view Nuplazid’s prescribing information.

Serious side effects

Serious side effects from Nuplazid aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • QT prolongation (a change in your heart rhythm that may be serious). Symptoms can include:
    • fainting
    • trouble breathing
    • heart palpitations
  • Hallucinations.* Symptoms can include:
    • seeing things that aren’t really there
    • hearing sounds or voices that aren’t really there
  • Allergic reaction.*
  • Increased risk for death in older adults with dementia-related psychosis.*†

* For more information on these side effects, see “Side effect details” below.
† Nuplazid has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “FDA warning: Increased risk of death in older adults with dementia-related psychosis” section at the beginning of this article.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Nuplazid. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

It’s not known how often allergic reaction occurred in people taking Nuplazid in clinical trials.

Call your doctor right away if you have a severe allergic reaction to Nuplazid. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Hallucinations

While taking Nuplazid, some people may experience hallucinations (seeing or hearing things that aren’t really there). In clinical trials, hallucinations occurred in:

  • 5% of people taking Nuplazid
  • 3% of people taking a placebo (a treatment with no active drug)

It’s not known whether people’s hallucinations got worse during clinical trials, or if their treatment wasn’t effective at reducing hallucinations they were already experiencing.

If you or your family or friends notice that you’re experiencing hallucinations while taking Nuplazid, talk with your doctor. They may have you switch to a different medication to treat your condition.

Peripheral edema

Peripheral edema (swelling of the arms, legs, hands, or feet) is a common side effect that may occur when taking Nuplazid. In clinical trials, peripheral edema occurred in:

  • 7% of people taking Nuplazid
  • 2% of people taking a placebo

If you experience peripheral edema while taking Nuplazid, talk with your doctor. They may be able to recommend ways to relieve this side effect. They may also recommend a different medication to treat your condition.

Nausea

Nausea is a common side effect that some people may experience while taking Nuplazid.

In clinical trials, nausea occurred in:

  • 7% of people taking Nuplazid
  • 4% of people taking a placebo

If you experience nausea while taking Nuplazid, talk with your doctor. They may be able to recommend ways to relieve this side effect.

Confusion

Some people may experience confusion while taking Nuplazid. Confusion was a common side effect that people taking Nuplazid experienced in clinical trials.

In the trials, confusion occurred in:

  • 6% of people taking Nuplazid
  • 3% of people taking a placebo

If you or your family or friends notice that you become confused while taking Nuplazid, talk with your doctor. They may recommend ways to decrease your confusion, or they may recommend a different medication to treat your condition.

Increased risk of death in older adults with dementia-related psychosis

Older adults with psychosis (loss of contact with reality) related to dementia may have a higher risk for death when taking antipsychotic drugs such as Nuplazid. (People with dementia have trouble with their memory, communication, and ability to think.)

Nuplazid shouldn’t be used in people with dementia-related psychosis that’s not related to Parkinson’s disease psychosis. Nuplazid has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA.

Clinical studies looked at older adults with dementia-related psychosis. Most people in the studies were taking atypical antipsychotic drugs such as Nuplazid. In these studies, the rate of death was:

  • 4.5% in people taking atypical antipsychotic drugs
  • 2.6% in people taking a placebo

It’s important to note that your results from taking Nuplazid may vary from those seen in clinical studies. If you have questions about whether Nuplazid is right for you, talk with your doctor.

The Nuplazid dosage your doctor prescribes will depend on several factors. These include:

  • the form of Nuplazid you take
  • other medical conditions you may have
  • other medications that you are taking

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Nuplazid comes as a capsule or tablet. The capsule is available in a strength of 34 milligrams (mg). The tablet comes in a strength of 10 mg. The tablet also used to be available in a strength of 17 mg. However, that strength was discontinued and is no longer available.

Dosage for Parkinson’s disease psychosis

The typical dose of Nuplazid to treat hallucinations and delusions* related to Parkinson’s disease psychosis is 34 mg taken once a day.

In some cases, people taking certain other medications with Nuplazid may only be able to take 10 mg of Nuplazid once a day. Talk with your doctor about any other medications you’re taking before you start Nuplazid. They can determine the best dose of Nuplazid for you to take.

* A hallucination is seeing or hearing something that isn’t really there. A delusion is believing something that isn’t true, and such beliefs may often be unrealistic.

What if I miss a dose?

If you miss your dose of Nuplazid, take it as soon as you remember. However, if it’s close to the time of your next dose, just skip the missed dose and take your next dose as scheduled. If you aren’t sure if you should take the missed dose, talk with your doctor or pharmacist.

To help make sure you don’t miss a dose, try using a medication reminder. A kitchen timer can work, too.

Will I need to use this drug long term?

Nuplazid is meant to be used as a long-term treatment. If you and your doctor determine that Nuplazid is safe and effective for you, you’ll likely take it long term.

The Food and Drug Administration (FDA) approves prescription drugs such as Nuplazid to treat certain conditions. Nuplazid may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Nuplazid for Parkinson’s disease psychosis

Nuplazid is FDA-approved to treat hallucinations and delusions related to Parkinson’s disease psychosis. A hallucination is seeing or hearing something that isn’t really there. A delusion is believing something that isn’t true, and such beliefs may often be unrealistic.

Parkinson’s disease is a condition that affects your nervous system. It’s a progressive disease, which means that it gets worse over time. More common symptoms can include tremors (shaking), slow movements, and stiff muscles.

Some people with Parkinson’s disease may also experience psychosis (loss of contact with reality). It’s the hallucinations or delusions caused by this psychosis that Nuplazid is used to treat.

Effectiveness for Parkinson’s disease psychosis

Nuplazid has been shown to be effective for treating hallucinations or delusions that are related to Parkinson’s disease psychosis.

In clinical trials, the effectiveness of Nuplazid was measured using a test called the Scale for the Assessment of Positive Symptoms of Parkinson’s Disease (SAPS-PD). This scale goes from 0 to 45, and a higher score means more severe symptoms.

In clinical trials:

  • people taking Nuplazid had their SAPS-PD scores decrease by 5.79 points
  • people taking a placebo (a treatment with no active drug) had their SAPS-PD scores decrease by 2.73 points

Off-label uses for Nuplazid

In addition to the use listed above, Nuplazid may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one or more uses is prescribed for a different one that’s not approved. Below are examples of off-label uses for Nuplazid.

Nuplazid for schizophrenia

Nuplazid isn’t FDA-approved to treat schizophrenia. However, in some cases the drug may be used off-label to treat this condition.

Schizophrenia is a mental health condition. A person with schizophrenia may act in confusing or abnormal ways. They may also experience psychosis, including hallucinations and delusions.

Symptoms of schizophrenia can be classified as positive, negative, or cognitive.

  • Positive symptoms: Thoughts or behaviors that occur in people with schizophrenia but that may not occur in people without the condition. Examples include hallucinations, delusions, unusual thoughts, and changes in body movements.
  • Negative symptoms: Symptoms that may cause someone to show little or no emotion, or no desire to socialize.
  • Cognitive symptoms: Symptoms that affect someone’s memory and their ability to think. Examples include having trouble paying attention, remembering things, or staying focused.

A clinical trial looked at Nuplazid use in people who had negative symptoms of schizophrenia. The trial showed that people taking Nuplazid had a decrease in negative symptoms compared with people taking a placebo.

Nuplazid is also being studied as an adjunct treatment for schizophrenia. (This means Nuplazid would be used along with other drugs to treat schizophrenia.)

If you have schizophrenia and are interested in taking Nuplazid, talk with your doctor.

Nuplazid for Lewy body dementia

Nuplazid isn’t FDA-approved to treat Lewy body dementia (LBD). However, Nuplazid may be used off-label in some cases to treat this condition.

LBD is a type of dementia. It’s a progressive condition, which means it gets worse over time. People with LBD may experience symptoms such as memory problems, hallucinations, muscle stiffness, and tremor.

One study looked at people who had LBD with psychosis and people with Parkinson’s disease who had psychosis. People took either Nuplazid or quetiapine (Seroquel). Quetiapine is a drug that can be used to treat psychosis. The results showed that Nuplazid and quetiapine were similarly effective at treating psychosis.

Another study looked at people taking Nuplazid who had dementia from any cause. The results showed significant improvements in people with dementia who were taking Nuplazid compared with people taking a placebo. In fact, the study was stopped early because the results were so promising. The next step will be for Nuplazid to gain FDA approval for use in people with dementia.

It’s important to note that Nuplazid has a boxed warning about people with dementia-related psychosis that’s not related to Parkinson’s disease psychosis taking antipsychotic drugs. (Nuplazid is an antipsychotic drug.) In some cases, older adults with dementia-related psychosis who take antipsychotics may have an increased risk for death. See the “Side effect details” section to learn more.

If you’re interested in using Nuplazid off-label to treat LBD, talk with your doctor.

Nuplazid for Alzheimer’s disease

Nuplazid isn’t FDA-approved to treat Alzheimer’s disease. However, it may be an off-label option for treating this condition. Alzheimer’s disease is a type of dementia that causes your memory and brain function to decline. It’s a progressive condition, which means it gets worse with time.

If you’re interested in taking Nuplazid to treat your Alzheimer’s disease, talk with your doctor.

Nuplazid for dementia-related psychosis

Nuplazid isn’t FDA approved for use in people with dementia-related psychosis that’s not related to Parkinson’s disease psychosis.

In fact, Nuplazid has a boxed warning about people with dementia-related psychosis that’s not related to Parkinson’s disease psychosis taking antipsychotic drugs. (Nuplazid is an antipsychotic drug.) In some cases, older adults with dementia-related psychosis who take antipsychotics may have an increased risk for death. (See the “Side effect details” section to learn more.)

However, in some cases, Nuplazid may be used off-label to treat dementia-related psychosis.

If you have questions about finding the best medication to treat your dementia-related psychosis, talk with your doctor.

No studies have been done on withdrawal or dependence related to taking Nuplazid. Dependence is when you need a medication to live normally. Withdrawal occurs when you’re dependent on a medication and you stop taking it. After you stop taking a drug you’re dependent on, in some cases you may develop symptoms of withdrawal, such as headaches, nausea, or vomiting.

In clinical trials, people taking Nuplazid didn’t show behaviors that indicated they were dependent on the drug or were experiencing withdrawal from the drug.

Nuplazid and children

Nuplazid isn’t FDA-approved for use in children. It’s not known if the drug is safe or effective for children.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Nuplazid, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat another condition.

Alternatives for Parkinson’s disease psychosis

Examples of other drugs that may be used to treat hallucinations and delusions related to Parkinson’s disease psychosis include:

You may wonder how Nuplazid compares with other medications that are prescribed for similar uses. Here we look at how Nuplazid and Seroquel are alike and different.

Ingredients

The active drug ingredient in Nuplazid is pimavanserin. The active drug ingredient in Seroquel is quetiapine.

Uses

Here is a list of conditions that the Food and Drug Administration (FDA) has approved Nuplazid and Seroquel to treat.

Seroquel is sometimes used off-label to treat hallucinations and delusions related to Parkinson’s disease psychosis. It’s not FDA-approved for this use.

Drug forms and administration

Nuplazid comes as a tablet or capsule that’s taken by mouth once a day. Seroquel is available as a tablet that’s taken by mouth twice a day. It’s also available as Seroquel XR, an extended-release tablet that’s taken once a day.

Side effects and risks

Nuplazid and Seroquel both contain medications that belong to a group called atypical antipsychotic drugs. Therefore, these medications can cause very similar side effects, but some different ones as well.

Below are examples of these side effects. The side effects listed below are for the approved uses of Seroquel. (These uses don’t include hallucinations or delusions related to Parkinson’s disease psychosis.)

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Nuplazid, with Seroquel, or with both drugs (when taken individually).

  • Can occur with Nuplazid:
    • confusion
    • nausea
  • Can occur with Seroquel:
    • feeling sleepy
    • dizziness
    • abdominal (belly) pain
  • Can occur with both Nuplazid and Seroquel:
    • constipation

Serious side effects

These lists contain examples of serious side effects that can occur with Nuplazid, with Seroquel, or with both drugs (when taken individually).

* Seroquel has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA.
† Nuplazid and Seroquel both have a boxed warning for this side effect. For more information, see “FDA warning: Increased risk of death in older adults with dementia-related psychosis” at the beginning of this article.

Effectiveness

Nuplazid is FDA-approved for use in people with hallucinations and delusions related to Parkinson’s disease psychosis. Seroquel isn’t approved for this use, but it may be used off-label for this purpose.

The use of Nuplazid and Seroquel in treating psychosis associated with Parkinson’s disease has been directly compared in a clinical study. This study also included people with psychosis related to a condition called Lewy body dementia.

The study showed that Nuplazid and Seroquel were similarly effective at improving psychosis. The drugs also had similar results in terms of the rate of death in people taking them and how long people went before stopping treatment.

However, one difference was the main reason people stopped treatment with each drug:

  • 53.3% of people who stopped taking Nuplazid did so because they didn’t think the drug was working, compared with 10% of people who stopped taking Seroquel
  • 70% of people who stopped taking Seroquel did so because of side effects, compared with 13.3% of people who stopped taking Nuplazid

Costs

The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Nuplazid and Seroquel are both brand-name drugs. There is currently no generic form of Nuplazid. However, there is a generic form of Seroquel called quetiapine. Brand-name medications usually cost more than generics.

Nuplazid and Clozaril are prescribed for similar uses. Here we look at how these drugs are alike and different.

Ingredients

The active drug ingredient in Nuplazid is pimavanserin. The active drug ingredient in Clozaril is clozapine.

Uses

Here is a list of conditions that the Food and Drug Administration (FDA) has approved Nuplazid and Clozaril to treat.

Clozaril isn’t FDA-approved to treat hallucinations or delusions related to Parkinson’s disease psychosis. However, in some cases, your doctor may recommend that you take Clozaril off-label for this use.

Drug forms and administration

Nuplazid is available as a tablet or capsule that is taken by mouth. Clozaril is also available as a tablet that is taken by mouth.

Side effects and risks

Nuplazid and Clozaril have some similar side effects and others that vary. Below are examples of these side effects. However, because Clozaril isn’t approved to treat hallucinations or delusions related to Parkinson’s disease psychosis, these side effects are for the approved uses of Clozaril only.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Nuplazid, with Clozaril, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Nuplazid, with Clozaril, or with both drugs (when taken individually).

* Clozaril has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA.
† Nuplazid and Clozaril both have a boxed warning for this side effect. For more information, see “FDA warning: Increased risk of death in older adults with dementia-related psychosis” at the beginning of this article.

Effectiveness

These drugs haven’t been directly compared in clinical studies. However, studies have found both Nuplazid and Clozaril to be effective for treating hallucinations or delusions related to Parkinson’s disease psychosis.

Costs

The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Nuplazid and Clozaril are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

Here are answers to some frequently asked questions about Nuplazid.

Will Nuplazid cure my Parkinson’s disease psychosis?

No, Nuplazid won’t cure your Parkinson’s disease psychosis. There is currently no cure for this condition. However, it can help decrease hallucinations and delusions that may be caused by Parkinson’s disease psychosis.

Talk with your doctor if you have questions about how Nuplazid works to treat your condition.

How can I safely stop taking Nuplazid?

You shouldn’t stop taking Nuplazid without first talking with your doctor. This is because if you stop taking Nuplazid, your symptoms of Parkinson’s disease psychosis may return. However, stopping Nuplazid shouldn’t cause withdrawal symptoms. (See the “Nuplazid withdrawal and dependence” section to learn more.)

If you’re planning to stop your Nuplazid treatment, talk with your doctor about the best way to do so.

Will Nuplazid make my hallucinations worse?

It’s not likely that Nuplazid will worsen your hallucinations, but it can happen. In clinical trials:

  • 5% of people taking Nuplazid experienced hallucinations
  • 3% of people taking a placebo (a treatment with no active drug) experienced hallucinations

It’s not known whether people’s hallucinations got worse during clinical trials, or if their treatment wasn’t effective at reducing hallucinations they were already experiencing.

If you notice that your hallucinations are getting worse while taking Nuplazid, talk with your doctor. They may be able to determine if the hallucinations are a side effect of Nuplazid.

Can I take Nuplazid if I’m taking carbidopa/levodopa for Parkinson’s disease?

Yes, you can continue to take carbidopa/levodopa (such as Rytary, Duopa, Sinemet) while taking Nuplazid. There are no interactions between these medications. However, always tell your doctor about any medications you take before starting Nuplazid.

Will Nuplazid have an effect on my Parkinson’s movement issues?

It’s not likely. In clinical trials, Nuplazid wasn’t reported to have an effect on people’s movement issues. Talk with your doctor if you have questions about how Nuplazid will affect your symptoms of Parkinson’s disease.

Does Nuplazid cause any heart side effects?

Nuplazid may cause heart side effects, such as an irregular heart rhythm called QT prolongation. However, in most cases QT prolongation only occurs if you’re taking another drug that also affects your heart rhythm. Or this could also occur if you have a condition that causes an irregular heart rhythm.

For more information on which medications to avoid while you’re taking Nuplazid, see the “Nuplazid interactions” section below. To learn about prolonged QT interval, which could cause QT prolongation during your Nuplazid treatment, see the “Nuplazid precautions” section below.

Nuplazid is FDA-approved for use in adults with hallucinations and delusions related to Parkinson’s disease psychosis. (A hallucination is seeing or hearing something that isn’t really there. A delusion is believing something that isn’t true, and such beliefs may often be unrealistic.)

About Parkinson’s disease psychosis

Parkinson’s disease is a condition that affects your nervous system. It’s a progressive disease, which means that it gets worse over time. Symptoms of Parkinson’s disease can include tremors (shaking), slow movements, and stiff muscles.

Some people with Parkinson’s disease may also experience hallucinations or delusions, which are symptoms of psychosis (loss of contact with reality). Causes of Parkinson’s disease psychosis can include medications, delirium, and depression.

What Nuplazid does

Nuplazid belongs to a group of medications called atypical antipsychotics. It’s not known exactly how Nuplazid works to treat hallucinations and delusions related to Parkinson’s disease psychosis. However, it’s believed that Nuplazid works on serotonin receptors in your brain.

Serotonin is a chemical that controls your mood and behavior. A receptor is a type of protein on a cell’s surface. It enables substances, such as the molecules of a drug, to attach to the protein and relay a chemical message.

By binding to specific serotonin receptors, Nuplazid may decrease the number of hallucinations or delusions you have from Parkinson’s disease psychosis.

How long does it take to work?

Nuplazid takes a while to begin working in your body. You may start to notice you’re having fewer hallucinations or delusions about 4 weeks after starting the drug. However, in some people, it may take 6 weeks for Nuplazid to work.

Talk with your doctor if you have questions about when you should start seeing results from Nuplazid.

You should take Nuplazid according to your doctor’s or healthcare provider’s instructions.

The drug comes as a capsule or a tablet that’s taken by mouth.

When to take

Nuplazid should be taken once a day. It can be taken at any time of day, but you should try to take your dose around the same time each day. This is so you have a consistent amount of medication in your body.

To help make sure you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Taking Nuplazid with food

You can take Nuplazid with or without food.

Can Nuplazid be crushed, split, or chewed?

The manufacturer of Nuplazid hasn’t stated whether the drug can be crushed, split, or chewed. If you have trouble swallowing the tablets or capsules, talk with your pharmacist or doctor. They may be able to recommend easier ways to take your medication or a different medication to treat your condition.

There are no known interactions between Nuplazid and alcohol. If you drink alcohol, talk with your doctor about how much is safe to drink during your treatment for Parkinson’s disease.

Nuplazid can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Nuplazid and other medications

Below is a list of medications that can interact with Nuplazid. This list doesn’t contain all drugs that may interact with Nuplazid.

Before taking Nuplazid, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Nuplazid and certain heart medications

Nuplazid may interact with certain heart medications that prolong (lengthen) your QT interval. The QT interval is part of your heart rhythm, and if it becomes too long, it can lead to an irregular heart rate or rhythm.

Nuplazid may prolong the QT interval. Therefore, taking it with heart medications that can also prolong the QT interval could raise your risk for this side effect even more.

The type of heart medications that can prolong your QT interval are called antiarrhythmics. These drugs shouldn’t be taken with Nuplazid. Examples of antiarrhythmics include:

  • quinidine
  • procainamide
  • disopyramide (Norpace)
  • amiodarone (Pacerone)
  • sotalol (Betapace)

Before starting Nuplazid, talk with your doctor about any medications you’re taking. They can determine if these drugs may interact with Nuplazid.

Nuplazid and certain antipsychotics

Nuplazid shouldn’t be taken with certain antipsychotic medications that can prolong (lengthen) your QT interval. The QT interval is part of your heart rhythm, and if it becomes too long, it can cause an irregular heart rate or rhythm.

Nuplazid may prolong the QT interval. Therefore, taking it with other medications that can also prolong the QT interval could raise your risk for this side effect even more.

Examples of the antipsychotic drugs that shouldn’t be taken with Nuplazid include:

  • ziprasidone (Geodon)
  • chlorpromazine
  • thioridazine

If you’re taking an antipsychotic medication, talk with your doctor. They can determine if the medication interacts with Nuplazid.

Nuplazid and certain antibiotics

Nuplazid may interact with certain antibiotics that can prolong (lengthen) your QT interval. The QT interval is part of your heart rhythm, and if it becomes too long, it can cause an irregular heart rate or rhythm.

Nuplazid may prolong the QT interval. Therefore, taking it with other medications that can also prolong the QT interval could raise your risk for this side effect even more.

Examples of the antibiotics that may interact with Nuplazid include:

  • gatifloxacin (Zymar)
  • moxifloxacin

If you’re taking an antibiotic, talk with your doctor before starting Nuplazid. They can determine if your medication interacts with Nuplazid. Your doctor may recommend that you take a different antibiotic to treat your infection. They may also monitor your heart rhythm while you’re taking both drugs to make sure you don’t experience irregular heart rhythm.

Nuplazid and CYP3A4 inhibitors

Nuplazid may interact with medications that are CYP34A inhibitors.

Nuplazid is broken down by a protein in your liver called CYP3A4. Other drugs, called CYP3A4 inhibitors, block this protein from working as it should. If CYP3A4 can’t properly break down Nuplazid, the amount of Nuplazid in your body can get too high. This may raise your risk for serious side effects.

Examples of medications that are CYP3A4 inhibitors include:

  • itraconazole (Tolsura, Sporanox)
  • ketoconazole (Extina, Xolegel)
  • clarithromycin
  • indinavir (Crixivan)

If you’re taking a medication that’s a CYP3A4 inhibitor, your doctor will likely lower your dose of Nuplazid. This can help prevent Nuplazid from building up in your body.

Before starting Nuplazid, talk with your doctor about any medications you take. They can determine if the medications are CYP3A4 inhibitors, and if you’ll need to decrease your Nuplazid dosage.

Nuplazid and CYP3A4 inducers

You shouldn’t take Nuplazid with medications that are CYP34A inducers.

Nuplazid is broken down by a protein in your liver called CYP3A4. Other drugs, called CYP3A4 inducers, make this protein work faster than usual.

If you take Nuplazid with a CYP3A4 inducer, your body will break down Nuplazid too quickly. This could lead to you not having enough Nuplazid in your body, which could make the drug less effective.

Examples of medications that are CYP3A4 inducers include:

  • modafinil (Provigil)
  • carbamazepine (Tegretol)
  • phenytoin (Dilantin)
  • rifampin (Rifadin)
  • thioridazine
  • efavirenz (Sustiva)
  • nafcillin

Talk with your doctor or pharmacist about any medications you take before starting Nuplazid. They can determine if the medications are CYP3A4 inducers and if they’re safe to take with Nuplazid.

Nuplazid and herbs and supplements

St. John’s wort, a supplement that is often used for depression, may interact with Nuplazid. You shouldn’t take St. John’s wort during your Nuplazid treatment.

Nuplazid is broken down by a protein in your liver called CYP3A4. St John’s wort is a CYP3A4 inducer, which means it makes this protein work faster than usual. Taking St. John’s wort with Nuplazid could make your body break down Nuplazid too quickly. This may make Nuplazid less effective.

Before starting Nuplazid, talk with your doctor or pharmacist about any supplements or herbs that you’re taking. They can tell you if the supplements or herbs are safe to take with Nuplazid.

Nuplazid and foods

Nuplazid may interact with grapefruit. Therefore, you should avoid drinking grapefruit juice or eating grapefruit while taking Nuplazid.

Nuplazid is broken down by a protein in your liver called CYP3A4. Grapefruit and grapefruit juice block this protein from working as it normally does. If CYP3A4 can’t properly break down Nuplazid, the amount of Nuplazid in your body can get too high. This may raise your risk for serious side effects.

The manufacturer of Nuplazid doesn’t provide a specific recommendation about grapefruit. If you have questions about consuming grapefruit or grapefruit juice during your Nuplazid treatment, talk with your doctor.

As with all medications, the cost of Nuplazid can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Nuplazid, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Nuplazid, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Nuplazid, or if you need help understanding your insurance coverage, help is available.

Acadia Pharmaceuticals, the manufacturer of Nuplazid, offers a program called NUPLAZIDconnect. This program may be able to help lower the cost of the drug for you. For more information and to find out if you’re eligible for support, call 844-737-2223 or visit the program website.

Generic version

Nuplazid isn’t available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

It’s not known if Nuplazid is safe to take during pregnancy. No human studies have looked at whether Nuplazid has any effects on a fetus.

In some animal studies, no developmental issues were seen in pregnant animals taking Nuplazid. However, in other animal studies, Nuplazid caused miscarriage and lower body weight in offspring born to mothers taking Nuplazid. It also caused negative side effects in the mother in some cases.

It’s important to note that animal studies don’t always predict what will happen in humans. If you’re pregnant or planning to become pregnant, talk with your doctor about the benefits and risks of using Nuplazid during pregnancy.

It’s not known if Nuplazid is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Nuplazid.

For more information about taking Nuplazid during pregnancy, see the “Nuplazid and pregnancy” section above.

It’s not known if Nuplazid is safe to take while breastfeeding. Clinical studies haven’t looked at whether Nuplazid is present in breast milk or if it may have an effect on a breastfed child. If you’re breastfeeding or planning to breastfeed, talk with your doctor about the risks and benefits of taking Nuplazid.

This drug comes with several precautions.

FDA warning: Increased risk of death in adults with dementia-related psychosis

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Older adults with psychosis related to dementia may have a higher risk for death when taking antipsychotic drugs such as Nuplazid. This drug should not be used in people with dementia-related psychosis that’s not related to Parkinson’s disease psychosis.

Other precautions

Before taking Nuplazid, talk with your doctor about your health history. Nuplazid may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Certain heart conditions, such as prolonged QT interval. Nuplazid may prolong (lengthen) your QT interval, which is part of your heart rhythm. Nuplazid shouldn’t be taken with other drugs that can also prolong your QT interval. This is because if the QT interval is prolonged too much, it can cause an irregular heart rhythm, which can be serious. Talk with your doctor about any medications you’re taking before starting Nuplazid. They can make sure your current medications are safe to take with Nuplazid.
  • Allergic reaction. If you’ve had an allergic reaction to Nuplazid or any of its ingredients, you shouldn’t take Nuplazid. Ask your doctor what other medications are better options for you.
  • Pregnancy. It’s not known if Nuplazid is safe to take during pregnancy. For more information, see the “Nuplazid and pregnancy” section above.
  • Breastfeeding. It’s not known if Nuplazid is safe to take while breastfeeding. For more information, see the “Nuplazid and breastfeeding” section above.

Note: For more information about the potential negative effects of Nuplazid, see the “Nuplazid side effects” section above.

Do not use more Nuplazid than your doctor recommends. For some drugs, doing so can lead to unwanted side effects or overdose.

What to do in case you take too much Nuplazid

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

When you get Nuplazid from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Nuplazid tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light. If necessary, this drug can be stored for short periods of time at temperatures of 59°F to 86°F (15°C to 30°C).

Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Nuplazid and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Nuplazid is approved to treat hallucinations and delusions associated with Parkinson’s disease psychosis in adults.

Administration

Nuplazid is taken orally, once daily. It can be taken without regard to food.

Mechanism of action

It is not known how Nuplazid works to treat hallucinations and delusions associated with Parkinson’s disease psychosis. However, it is believed that Nuplazid may work on the 5-HT2A receptor as an inverse agonist and antagonist. It may also work on the 5-HT2C receptor as well. Nuplazid may decrease hallucinations and delusions by acting on these serotonin receptors.

Pharmacokinetics and metabolism

Nuplazid takes about 6 hours to be at maximum concentration, with a range from 4 hours to 24 hours.

Nuplazid is about 95% protein bound. The volume of distribution after one dose of 34 mg of Nuplazid is 2,173 L.

The half-life of Nuplazid is about 57 hours. The half-life of the active metabolite of Nuplazid is 200 hours.

This medication is mainly eliminated by CYP3A4 and CYP3A5. It is also metabolized by CYP2J2, CYP2D6, and other CYP enzymes.

Contraindications

Nuplazid is contraindicated in patients with a known allergy to the active ingredient, pimavanserin, or any of the ingredients in Nuplazid tablets or capsules.

Misuse, withdrawal, and dependence

Nuplazid is not a controlled substance. In clinical trials, people taking Nuplazid did not show signs of dependence or withdrawal.

Storage

Nuplazid tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light. If necessary, this drug can be stored for short periods of time at temperatures of 59°F to 86°F (15°C to 30°C).

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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