“Managing the Menagerie in My Home”, Successful Clozapine Titration for “Pimavanserin-Resistant” Parkinson's Disease Psychosis

Lake, Adam; Hill, Michael A.; Lunsford, Julia

doi:10.1016/j.jagp.2020.01.146

Cited by 1 publication

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“…Lake et al reported an elderly female with PD psychosis resistant to quetiapine and PMV monotherapy regimen. A trial of clozapine after a suboptimal response to PMV led to further symptom improvement [ 67 ]. Noteworthily, the decision should have a patient-centered approach due to the high potential side-effect burden.…”

Section: Pimavanserin Clinical Experiencementioning

confidence: 99%

Pimavanserin and Parkinson’s Disease Psychosis: A Narrative Review

et al. 2022

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Pimavanserin (PMV) is the first approved drug for treating hallucinations and delusions in Parkinson’s disease (PD) psychosis. Psychosis is one of the leading causes of nursing home placement in people with PD. Furthermore, hallucinations are a more frequent cause of institutionalization than motor disability or dementia related to PD. The management of PD psychosis involves antipsychotic medications. Most of the drugs in this class directly block dopamine D2 receptors, leading to significantly worsening motor symptoms in patients with PD. The most commonly used medications for managing PD psychosis are quetiapine, clozapine, and PMV. This literature review aims to study pimavanserin’s history, mechanism, clinical trials, and post-marketing experience. PMV is a potent 5-HT2A receptor antagonist/inverse agonist. Moreover, this drug can interact with 5-HT2C receptors. We calculated some physicochemical descriptors and pharmacokinetic properties of PMV. Eight clinical trials of PMV and PD psychosis are registered on ClinicalTrials.gov. Only four of them have complete results already published. Meta-analytic results showed that PMV efficacy is inferior to clozapine. However, PMV has a significantly lower number of side-effects for managing psychosis in PD. Medicare database assessment revealed 35% lower mortality with PMV compared to other atypical antipsychotics. Moreover, sensitive statistical analysis demonstrated that PMV is a protective factor for the risk of falls in individuals with PD.

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Section: Pimavanserin Clinical Experiencementioning

confidence: 99%