Atypical antipsychotic, selective 5-HT2A inverse agonist/antagonist
Selective inverse agonist and antagonist at serotonin 5-HT2A receptors, with minimal to no dopamine receptor blockade, reducing extrapyramidal symptom risk
Parkinson’s disease psychosis (PDP)
Psychosis in other neurodegenerative disorders, adjunctive treatment in mood and psychotic disorders
Oral tablets (17 mg)
34 mg p.o. daily (two 17 mg tablets), no titration required
34 mg/day
Metabolized primarily by CYP3A4; avoid concomitant use with strong CYP3A4 inhibitors or inducers; half-life ~55 hours
Peripheral edema, nausea, confusion
QTc prolongation, neuropsychiatric worsening (hallucinations, delirium)
ECG monitoring for QTc prolongation risk, mental status monitoring for neuropsychiatric symptoms
Increased mortality in elderly patients with dementia-related psychosis unrelated to Parkinson’s disease
Pimavanserin is particularly beneficial for managing psychosis in Parkinson’s disease due to its lack of dopamine receptor blockade, minimizing extrapyramidal symptoms. It is not recommended for elderly patients with dementia-related psychosis unrelated to Parkinson’s or Alzheimer’s disease because of increased mortality risk.