Pimavanserin use in a movement disorders clinic: A single center experience

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Conference Proceeding

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Objective: To assess clinical outcomes of Pimavanserin use in Parkinson disease associated psychosis (PDP). Background: Dopamine-receptor blockers (DRB) are used to treat PDP symptoms, though these may be associated with adverse effects, including worsening of Parkinsonism. There is a paucity of comparative studies with conventional neuroleptics. Pimavanserin, a selective 5-HT receptor inverse agonist, was FDA-approved in 2016 for treatment of PDP. Design/Methods: A retrospective chart review of patients prescribed pimavanserin was performed in August, 2017. Data on demographics, psychotic features, sleep, adverse effects was collected using a semi-structured telephone interview with patients and caregivers. Hallucination severity (HS) was quantified as mild (/week), moderate (1/week to <1/day) or severe (daily/continuous). Results: 17 patients consented to participate in the study: 16 were diagnosed with PDP, 1 with Lewy body dementia. Mean duration of Parkinsonism was 11.8±8.0years, with 2.6±1.9 years of psychotic symptoms. At baseline, 93% reported severe hallucinations and 7%, moderate hallucinations. Three PDP patients discontinued pimavanserin by the time of interview (2 because of no benefit; 1 due to remission). 71.4% reported improvement of hallucination with pimavanserin. 6 patients received pimavanserin monotherapy: 33.3% reported no change in HS, 50% improved from severe to mild, and 16.6% improved from severe to moderate. 8 patients receiving pimavanserin and DRB: 2 reported no change in HS, 25% reported a change from severe to mild hallucinations, 37.5% reported decrease from severe to moderate hallucinations and 12.5% reported decrease from moderate to mild hallucinations. Five of 9 patients prescribed DRB (quetiapine and olanzapine) discontinued these medications with pimavanserin initiation. No major side effects were reported. One patient noted subjective improvement of sleep. Conclusions: Our survey, based on reallife experience shows that pimavanserin is well-tolerated and efficacious in treatment of PDP. It appears to be effective as both monotherapy and adjuvant treatment for moderate to severe psychosis for most patients.




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