Pimavanserin
Pimavanserin is an atypical antipsychotic used to treat hallucinations and delusions associated with Parkinson's disease psychosis.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 2 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾
Important safety warning: Increased risk of death in elderly patients with dementia-related psychosis. Older adults who have dementia and are treated with antipsychotic drugs — including pimavanserin — have a higher chance of dying compared to those given a placebo. The deaths were often related to heart problems (such as heart failure or sudden death) or infections (such as pneumonia). Pimavanserin is NOT approved for dementia-related psychosis unless the hallucinations and delusions are directly caused by Parkinson's disease. If you or a family member has a different type of dementia, talk to your doctor about safer alternatives.
📖 Pimavanserin: Patient Information Guide
A plain-language walkthrough of Pimavanserin — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.
🎯What it's used for▾
Pimavanserin is an atypical antipsychotic with one approved use across its supported products:
- Nuplazid (capsule and tablet) is approved to treat hallucinations and delusions associated with Parkinson's disease psychosis in adults.
- Pimavanserin capsule (generic) is also approved for the same indication: hallucinations and delusions associated with Parkinson's disease psychosis.
- Pimavanserin is not approved for psychosis caused by other types of dementia — using it in that setting carries a serious risk of death.
⚙️How it works▾
Pimavanserin works by acting on serotonin receptors in the brain — specifically, it blocks and tones down the activity of 5-HT2A receptors (and, to a lesser degree, 5-HT2C receptors). This is thought to help reduce the hallucinations and delusions associated with Parkinson's disease psychosis. Importantly, pimavanserin does not significantly bind to dopamine receptors, which sets it apart from most antipsychotics and may help avoid worsening the movement symptoms of Parkinson's disease. The exact way it achieves its full effect is still not completely understood.
💊How it's taken▾
Pimavanserin is taken once daily by mouth, with or without food — meals do not meaningfully affect how much of the drug reaches your bloodstream. No dose build-up period is needed; it is started at the full recommended dose. Capsules (Nuplazid and pimavanserin generic) may be swallowed whole or opened and sprinkled over a soft food like applesauce, yogurt, or pudding — eat the mixture right away and do not save it. If you are also taking a strong CYP3A4 inhibitor, your prescriber may switch you to the Nuplazid tablet form at a lower dose. Always follow your prescriber's specific instructions.
🤒Side effects — in detail▾
The most common side effects reported in clinical trials include:
- Swelling of the legs or feet (peripheral edema) — occurred in about 7% of people taking pimavanserin
- Confusion or disorientation (confusional state) — occurred in about 6% of people
- Nausea — reported in about 7% of people
- Constipation
- Unsteady walking or gait disturbance
- Hallucinations — in a small number of patients, this was actually a reason for stopping the drug
Contact your doctor promptly if you notice a fast or irregular heartbeat, worsening confusion, or any signs of a severe allergic reaction such as swelling of the face, tongue, or throat — these are serious reactions that need medical attention right away.
⚠️Warnings & precautions▾
- Increased death risk in elderly patients with dementia (Boxed Warning): Antipsychotic drugs increase the risk of death in older adults with dementia-related psychosis. Pimavanserin is only approved for psychosis linked to Parkinson's disease — it must not be used for other types of dementia-related psychosis.
- Heart rhythm changes (QT prolongation): Pimavanserin lengthens the QT interval — a measure of how the heart's electrical system resets between beats. This can increase the risk of a serious, potentially life-threatening irregular heart rhythm. The risk is higher if you have existing QT prolongation, low potassium or magnesium, a slow heart rate, or take other medications that also prolong QT.
- Drug interactions with QT-prolonging medicines: Combining pimavanserin with certain heart, psychiatric, or antibiotic drugs that also affect QT can be dangerous. Your doctor and pharmacist should review all your medications.
🔀What it interacts with▾
Several types of medications can interact meaningfully with pimavanserin:
- QT-prolonging drugs (certain antiarrhythmics like quinidine, amiodarone, or sotalol; certain antipsychotics like ziprasidone or thioridazine; certain antibiotics like moxifloxacin) — combining these with pimavanserin increases the risk of dangerous heart rhythm problems and should be avoided.
- Strong CYP3A4 inhibitors (drugs that slow the liver enzyme that breaks down pimavanserin) — these raise pimavanserin blood levels significantly; your doctor may lower your pimavanserin dose if you need one of these medications.
- Strong or moderate CYP3A4 inducers (drugs that speed up the breakdown of pimavanserin) — these reduce how much active pimavanserin is in your body; this combination should be avoided because pimavanserin may not work effectively.
- Carbidopa/levodopa (common Parkinson's medication) — no dose adjustment is needed; pimavanserin does not affect how levodopa works in the body.
This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.
📋Before taking it▾
- Allergy: Do not take pimavanserin if you have had a serious allergic reaction (rash, hives, tongue or throat swelling, difficulty breathing) to pimavanserin or any of its ingredients.
- Heart rhythm problems: Tell your doctor if you have a history of heart arrhythmias, a prolonged QT interval, or abnormally low potassium or magnesium levels — these increase the risk of heart rhythm complications.
- Non-Parkinson's dementia: Pimavanserin is not approved — and carries a serious death risk — when used in elderly patients with dementia-related psychosis that is not caused by Parkinson's disease.
- Pregnancy: There are no adequate human studies on pimavanserin use during pregnancy. Animal studies at high doses showed maternal toxicity and lower pup survival. Discuss risks and benefits carefully with your doctor.
- Breastfeeding: It is unknown whether pimavanserin passes into human breast milk. Discuss with your doctor before breastfeeding.
- Children: Safety and effectiveness in pediatric patients have not been established.
- Kidney impairment: No dose adjustment is generally needed for mild to severe kidney impairment, but your doctor should be aware of your kidney function.
- Other medications: Share a full list of all your medications — including over-the-counter drugs and supplements — with your prescriber and pharmacist before starting pimavanserin.
🚑If you take too much▾
There is limited information about what a pimavanserin overdose looks like in people; in healthy volunteer studies, high doses caused nausea and vomiting. Because pimavanserin affects heart rhythm, an overdose requires immediate heart monitoring, including continuous ECG. If you think someone has taken too much, call Poison Control at 1-800-222-1222 right away or go to the nearest emergency room.
📡Pharmacodynamics — effects in the body▾
In laboratory studies, pimavanserin acts as an inverse agonist and antagonist at serotonin 5-HT2A receptors — meaning it not only blocks these receptors but actively damps down their baseline activity. It has a weaker effect at 5-HT2C receptors and very little interaction with dopamine, histamine, muscarinic, or adrenergic receptors. One measurable effect on the body is a modest lengthening of the QT interval — the part of the heart's electrical cycle that resets between beats — which is why careful attention to heart rhythm is important during treatment.
🔬Pharmacokinetics — how your body processes it▾
After swallowing a dose, pimavanserin reaches peak blood levels in about 6 hours, and food does not meaningfully change this. It is heavily protein-bound in the blood (about 95%) and is broken down mainly by liver enzymes (CYP3A4/3A5), producing an active breakdown product with a very long half-life of about 200 hours; pimavanserin itself has a half-life of about 57 hours, meaning it stays in the body for many days after the last dose. Very little of the drug is excreted unchanged in urine or stool — metabolism is the main route of elimination.
📦How to store it▾
34 mg Capsule: Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) . protect from light. Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) .
📄 Written from Pimavanserin’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →
Supplements & herbs that interact with Pimavanserin
153 supplements and herbal products have documented interactions with Pimavanserin in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 10
- Moderate · 103
- Minor · 40
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
🩺 Pharmacist Counseling Corner
Quick, plain-English answers to the questions patients ask most about Pimavanserin — the kind of thing our pharmacy team would talk through with you at the counter.
What exactly is pimavanserin used for? ▾
Can I open the capsule if I have trouble swallowing it? ▾
What side effects should I watch out for? ▾
Are there medications I need to avoid while taking pimavanserin? ▾
I've heard there's a serious warning about this drug in elderly people with dementia — should I be worried? ▾
Is it safe to take during pregnancy or while breastfeeding? ▾
Is Pimavanserin available over the counter? ▾
When was Pimavanserin first available? ▾
Who makes Pimavanserin? ▾
💬 Answers drafted from Pimavanserin’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →
🧰 Keep exploring
💊 How Pimavanserin comes
Pimavanserin is available in 2 forms. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Capsule
How this form is used
- Nuplazid capsule is used to treat hallucinations and delusions associated with Parkinson's disease psychosis.
- Pimavanserin capsule is indicated for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis.
- Nuplazid capsules can be swallowed whole or opened and the entire contents sprinkled over a tablespoon of applesauce, yogurt, pudding, or a liquid nutritional supplement — eat immediately without chewing and do not store for later.
- Pimavanserin capsules can be taken whole, or opened and sprinkled over a tablespoon of soft food or a liquid nutritional supplement — consume right away without chewing.
- Both Nuplazid and pimavanserin capsules can be taken with or without food.
- Pimavanserin capsules are taken once daily by mouth; no gradual dose increase is needed when starting.
Tablet
How this form is used
- Nuplazid tablet is used to treat hallucinations and delusions associated with Parkinson's disease psychosis.
- Nuplazid tablet (10 mg) is the form used when a dose reduction is needed due to taking a strong CYP3A4 inhibitor alongside Nuplazid.
- Nuplazid tablet is taken orally once daily.
- Nuplazid tablet can be taken with or without food.
📊 Pimavanserin across the U.S. market
How Pimavanserin appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
FDA-listed product records by dose form (tablet variants merged) — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
Also listed with the FDA, not a patient dose form: Powder (6) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
📈 How widely Pimavanserin is used
A general measure of how commonly Pimavanserin is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Pimavanserin is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Pimavanserin prescribed? Of the 1,597 medications we measure, Pimavanserin ranks #1,181 by Medicaid prescriptions — more than 26% of them.
Utilization by Pimavanserin product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
pimavanserin 34 MG Oral Capsule Most dispensed
Summed across the 1 of 4 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2049275
pimavanserin 10 MG Oral Tablet
Summed across the 1 of 2 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2049269
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Pimavanserin, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 2 of 6 listed Pimavanserin NDCs with Medicaid activity.
🔍 Compare Pimavanserin products
A representative set of FDA-listed product records for Pimavanserin — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Capsule | ||||
| 34 mg | Oral | Acadia Pharmaceuticals Inc. × 3 listings | NDA | View NDC → |
| 34 mg | — | Catalent Pharma Solutions, LLC | DRUG FOR FURTHER PROCESSING | View NDC → |
| 34 mg | Oral | Novadoz Pharmaceuticals LLC | ANDA | View label ↗ |
| 34 mg | — | Patheon Pharmaceuticals Inc. | DRUG FOR FURTHER PROCESSING | View NDC → |
| 💊Tablet | ||||
| 10 mg | Oral | Acadia Pharmaceuticals Inc. × 3 listings | NDA | View NDC → |
| 10 mg | — | Patheon Pharmaceuticals Inc. | DRUG FOR FURTHER PROCESSING | View NDC → |
| 💊Bulk drug substance | ||||
| 1 kg/kg | — | Biophore India Pharmaceuticals Private Limited | BULK INGREDIENT | View NDC → |
| 1 kg/kg | — | Dasami Lab Private Limited | BULK INGREDIENT | View NDC → |
| 1 kg/kg | — | MSN Life Sciences Private Limited | BULK INGREDIENT | View NDC → |
| 1 kg/kg | — | Siegfried AG | BULK INGREDIENT | View NDC → |
| 1 kg/kg | — | Siegfried Evionnaz SA | BULK INGREDIENT | View NDC → |
| 1 kg/kg | — | Zaklady Farmaceutyczne Polpharma S A | BULK INGREDIENT | View NDC → |
Showing 16 of 16 products — FDA National Drug Code Directory. See every product, package size and price: browse all 16 Pimavanserin NDCs →
📈 What people report — real-world data (FDA FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Pimavanserin — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Pimavanserin in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
🏛️ The road to your pharmacy
How Pimavanserin went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
🚨 Recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
Source: openFDA drug enforcement (recall) reports.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 1791685 2 dose forms · 2 strengths
Look up RxCUI 1791685 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
📦 Supply & shortage status
Whether Pimavanserin is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
🏷️ Sold under these brand names
🏭 Manufacturers & labelers
RxNorm drug class
Pimavanserin belongs to the Atypical Antipsychotic class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
🔬 Where this comes from
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How we combine label and product data
HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 2 FDA-filed SPL label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.
For canonical ingredient pages, bounded product-attributed indication and administration excerpts may be added to the AI evidence, and the generator is instructed to preserve available product, brand, route, and form qualifiers instead of treating one label as universal. Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. Novadoz Pharmaceuticals LLC is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.
This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.