From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dosage The recommended dose of NUPLAZID is 34 mg taken orally once daily, without titration.
The starting dose of Nuplazid is 34 mg taken orally once daily, without titration 1.
- The dose can be taken with or without food.
- No dose titration is required. However, the dose may need to be adjusted when coadministered with certain other medications, such as strong CYP3A4 inhibitors, in which case the recommended dose is 10 mg once daily 1.
From the Research
The starting dose of Nuplazid (pimavanserin) is 34 mg taken once daily, typically with or without food. This medication is primarily used to treat hallucinations and delusions associated with Parkinson's disease psychosis. The 34 mg dose is provided as two 17 mg tablets that should be taken together at the same time each day. No titration is required when initiating therapy, and this is the standard therapeutic dose for most patients. For patients with renal impairment or those taking strong CYP3A4 inhibitors (such as ketoconazole), the dose should be reduced to 17 mg daily. Nuplazid works by selectively targeting 5-HT2A receptors while avoiding dopamine receptors, which helps manage psychotic symptoms without worsening motor symptoms of Parkinson's disease, as shown in a study published in the Lancet in 2014 2. Patients should be monitored for potential side effects including confusion, constipation, and possible QT interval prolongation. The full therapeutic effect may take several weeks to develop, so patience with the treatment regimen is important.
Some key points to consider when prescribing Nuplazid include:
- The medication is well-tolerated, with no significant safety concerns or worsening of motor function, as demonstrated in a study published in 2017 3.
- Pimavanserin has been shown to reduce psychosis in PD without worsening motor symptoms, making it a welcome therapeutic option for this devastating symptom 4.
- The antipsychotic effect of pimavanserin can be attributed to serotonin 2a receptor (5-HT2A) triggered mechanisms, as discussed in a review published in 2017 5.
- Patients with a history of psychosis should be treated cautiously, as dopaminergic therapy can cause confusion, delirium, and psychotic-like behavior, as noted in a study published in 2017 6.
Overall, Nuplazid is an effective treatment option for patients with Parkinson's disease psychosis, and its use should be considered in patients who have not responded to other treatments or who are at risk of worsening motor symptoms.