INTRODUCTION: Pimavanserin (Nuplazid™) is an atypical antipsychotic currently 
indicated for the treatment of hallucinations and delusions associated with 
Parkinson disease psychosis. The antipsychotic effects of this new agent are 
believed to occur via selective inverse agonist activity at serotonin 5-HT2a 
receptors.
METHODS: Study authors completed a literature review of 2 published randomized 
controlled trials of pimavanserin for the treatment of Parkinson disease 
psychosis. The Food and Drug Administration Briefing Document by the 
Psychopharmacologic Drugs Advisory Committee for the review of pimavanserin 
dated March 29, 2016, was reviewed for additional information on 2 unpublished 
trials.
RESULTS: Pimavanserin has demonstrated no worsening of motor symptoms of 
Parkinson disease, but only 1 of 4 trials has shown consistent statistically 
significant improvements in psychotic symptoms compared with placebo.
DISCUSSION: Options for the treatment of Parkinson disease psychosis are 
limited. The selective receptor profile of pimavanserin offers advantages for 
tolerability. Further studies are warranted to better provide clinicians and 
patients with information regarding the clinical utility of this agent.