ISSUE 1496
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The FDA has approved the atypical antipsychotic pimavanserin (Nuplazid – Acadia) for treatment of hallucinations and delusions associated with Parkinson's disease. It is the first drug to be approved in the US for this indication.
PARKINSON'S DISEASE PSYCHOSIS — Hallucinations and delusions occur in up to 60% of patients with Parkinson's disease.1 Low doses of clozapine (Clozaril, and others) have been effective for treatment of these symptoms, but even in low doses clozapine can cause agranulocytosis, somnolence, and other significant toxicity.2,3 Low-dose quetiapine has been used off-label to treat Parkinson's disease psychosis, but it has not been effective in controlled trials.4,5 Both clozapine and quetiapine block dopamine receptors and could exacerbate the motor symptoms
... more- EB Forsaa et al. A 12-year population-based study of psychosis in Parkinson disease. Arch Neurol 2010; 67:996.
- The Parkinson Study Group. Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease. N Engl J Med 1999; 340: 757.
- The French Clozapine Parkinson Study Group. Clozapine in drug-induced psychosis in Parkinson's disease. Lancet 1999; 353:2041.
- P Shotbolt et al. Quetiapine in the treatment of psychosis in Parkinson's disease. Ther Adv Neurol Disord 2010; 3:339.
- P Desmarais et al. Quetiapine for psychosis in Parkinson disease and neurodegenerative Parkinsonian disorders: a systematic review. J Geriatr Psychiatry Neurol 2016 April 6 (epub).
- U Hacksell et al. On the discovery and development of pimavanserin: a novel drug candidate for Parkinson's psychosis. Neurochem Res 2014; 39:2008.
- J Cummings et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet 2014; 383:533.
- I Yasue et al. Serotonin 2A receptor inverse agonist as a treatment for Parkinson's disease psychosis: a systematic review and meta-analysis of serotonin 2A receptor negative modulators. J Alzheimers Dis 2016; 50:733.
- RL Woosley and KA Romero. QT drugs list. Available at www. crediblemeds.org. Accessed May 25, 2016.
- Inhibitors and inducers of CYP enzymes and P-glycoprotein. Med Lett Drugs Ther 2016; 58:e46.
- Approximate WAC. WAC = wholesaler acquisition cost or manufacturer's published price to wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. May 5, 2016. Reprinted with permission by First Databank, Inc. All rights reserved. ©2016. www.fdbhealth.com/policies/drug-pricing-policy.
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Article code: 1496b
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