Side Effects of pimavanserin: A Synthesis of Findings from 21 Studies

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Original Abstract of the Article

Main Research Findings

Pimavanserin, a selective 5-HT2A receptor inverse agonist, has been approved by the FDA for the treatment of Parkinson's disease psychosis (PDP). 11 Several studies have shown that pimavanserin is effective in treating hallucinations and delusions in PD patients, with a lower risk of worsening motor function and other side effects compared to conventional antipsychotics. 20 , 15 . Additionally, pimavanserin may be protective against the risk of falls in individuals with PD. 2 The drug is well tolerated in older males with DLB and may be useful in reducing distressful hallucinations, delusions, and paranoia. 1 .

Reasons for Side Effects

Pimavanserin's mechanism of action is related to its selective 5-HT2A receptor inverse agonism. 19 This means it acts on serotonin receptors, rather than dopamine receptors like traditional antipsychotics, which can contribute to Parkinsonism. 11 Therefore, pimavanserin is less likely to cause extrapyramidal side effects. 21 However, it can still cause side effects related to its action on serotonin receptors.

Common Side Effects

Gastrointestinal

Common gastrointestinal side effects reported in studies include constipation, nausea, vomiting, and abdominal pain. 20 , 15 .

Nervous System

Nervous system side effects reported include dizziness, drowsiness, and headache. 20 , 15 . In some patients, pimavanserin can also cause anxiety and insomnia. 19

Other

Other reported side effects include hypotension, weight gain, and rash. 20 However, these are relatively rare. 15

Countermeasures for Side Effects

Constipation

Constipation can be managed through dietary changes, increased fluid intake, and exercise. If these measures are insufficient, laxatives may be prescribed. 15

Nausea and Vomiting

Taking pimavanserin after meals or at bedtime may help reduce nausea and vomiting. Antiemetic medications may also be prescribed. 15

Dizziness

Rest and slow movements, especially when getting up, can help manage dizziness. Antivertigo medications may be prescribed. 15

Drowsiness

Adjusting the time of day pimavanserin is taken may help reduce drowsiness. Activities requiring alertness should be avoided, such as driving or operating machinery. 15

Headache

Pain relievers can often alleviate headaches. 15

Comparison Between Studies

Commonalities Between Studies

Multiple studies have found pimavanserin to be effective in treating psychosis in PD patients. 20 , 15 , 8 Most studies indicate a lower risk of motor function worsening compared to traditional antipsychotics. 20 , 15 , 14

Differences Between Studies

Some studies have shown different results regarding the effectiveness and side effects of pimavanserin. 20 found significant improvement in psychotic symptoms compared to placebo, while 2 suggests pimavanserin may be less effective than clozapine. These discrepancies might be due to factors like study design, participant characteristics, or specific doses used. 9

Precautions for Applying Research to Real Life

While pimavanserin shows promise for treating PD psychosis, it's essential to be aware of potential side effects. It's crucial to follow your doctor's instructions regarding dosage and administration. 15 , 9 Discuss potential side effects and countermeasures with your doctor before starting pimavanserin. 15 If you engage in activities that require alertness, be aware of the possibility of drowsiness or dizziness. 15

Current Research Limitations

Data on long-term safety and effectiveness of pimavanserin is still limited. 8 The impact of pimavanserin on the progression of PD is not yet fully understood. 15

Future Research Directions

Further research is necessary to investigate the long-term safety and effectiveness of pimavanserin, including its potential impact on PD progression. 15 , 8 Determining optimal dosages, administration methods, and interactions with other medications are crucial areas of future study. 15 , 9

Conclusion

Pimavanserin offers a potential treatment option for PD psychosis with a lower risk of motor function worsening than traditional antipsychotics. However, be aware of potential side effects, follow your doctor's instructions, and discuss concerns with them. Further research is needed to fully understand its long-term effects and optimize its use in clinical practice. 15 , 14

Literature analysis of 21 papers
Positive Content
19
Neutral Content
1
Negative Content
1
Article Type
1
0
0
6
21
2.

Pimavanserin and Parkinson's Disease Psychosis: A Narrative Review.

Author: RissardoJamir Pitton, DuranteÍcaro, SharonIdan, Fornari CapraraAna Letícia

Lower mortality
Protection from falls
Reduced motor symptoms

Pimavanserin is the first FDA-approved drug to treat hallucinations and delusions in Parkinson’s disease psychosis. It blocks a receptor in the brain, which is believed to cause fewer side effects than other medications. Studies have shown that pimavanserin is less effective than other medications, but it causes fewer side effects. It is also associated with lower mortality and a reduced risk of falls in people with Parkinson’s disease.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease.

Author: HeilmanKenneth M, NadeauStephen E

Reduce agitation
Reduce psychosis
Serious side effects

This review explores the treatment of emotional experience disorders in patients with Alzheimer's disease, focusing on pharmacological approaches and highlighting recent advancements in the treatment of psychosis and agitation/aggression.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

6.

Identification of a Serotonin 2A Receptor Subtype of Schizophrenia Spectrum Disorders With Pimavanserin: The Sub-Sero Proof-of-Concept Trial Protocol.

Author: BaltzersenOlga B, MeltzerHerbert Y, FrokjaerVibe G, RaghavaJayachandra M, BaandrupLone, FagerlundBirgitte, LarssonHenrik B W, FibigerH Christian, GlenthøjBirte Y, KnudsenGitte M, EbdrupBjørn H

Schizophrenia treatment

Current antipsychotics for schizophrenia target the dopamine receptor (D2R), but up to one-third of patients don't respond well or have side effects. Previous research suggests that blocking the serotonin 2A receptor (2AR) might be effective in a subgroup of patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Pimavanserin for Psychosis in Parkinson's Disease-Related Disorders: A Retrospective Chart Review.

Author: SellersJessie, DarbyR Ryan, FarooqueAlma, ClaassenDaniel O

Psychosis treatment

Pimavanserin, a newly approved treatment for Parkinson's disease psychosis, is showing promise in real-world settings. However, more research is needed to fully understand its long-term efficacy and outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

9.

Guidance for switching from off-label antipsychotics to pimavanserin for Parkinson's disease psychosis: an expert consensus.

Author: BlackKevin J, NasrallahHenry, IsaacsonStuart, StacyMark, PahwaRajesh, AdlerCharles H, AlvaGustavo, CooneyJeffrey W, KremensDaniel, MenzaMatthew A, MeyerJonathan M, PatkarAshwin A, SimuniTanya, MorrissetteDebbi A, StahlStephen M

PDP treatment
Lack of efficacy
Side effects

Patients with Parkinson's disease psychosis (PDP) are often treated with atypical antipsychotics, but side effects or lack of sufficient efficacy can motivate a switch to pimavanserin, the first medication approved for management of PDP. This article provides recommendations for safely and effectively switching patients from atypical antipsychotics to pimavanserin, taking into consideration each agent's pharmacokinetics, pharmacodynamics, receptor interactions, and the clinical reason for switching.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

13.

Atypical antipsychotic therapy in Parkinson's disease psychosis: A retrospective study.

Author: YuanMei, SperryLaura, Malhado-ChangNorika, DuffyAlexandra, WheelockVicki, FariasSarah, O'ConnorKevin, OlichneyJohn, ShahlaieKiarash, ZhangLin

PDP treatment
Drug reactions

This study reviews the adverse drug reactions (ADRs) associated with atypical antipsychotic drugs (APDs) used to treat Parkinson's disease psychosis (PDP). The study highlights the common ADRs of these drugs and the need for careful monitoring when treating PDP patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Novel pharmaceuticals in the treatment of psychosis in Parkinson's disease.

Author: BroadstockMartin, BallardClive, CorbettAnne

Reduced mortality
Treatment of PD psychosis
Motor symptom worsening

Parkinson's disease, affecting 10 million worldwide, can lead to psychosis in half of patients. While most antipsychotics are ineffective or worsen motor symptoms, clozapine has shown efficacy, but side effects limit its use. Pimavanserin, a novel drug targeting serotonin, has proven effective in clinical trials for Parkinson's disease with psychosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

17.

Lorcaserin and pimavanserin: emerging selectivity of serotonin receptor subtype-targeted drugs.

Author: MeltzerHerbert Y, RothBryan L

Treat Parkinson's disease psychosis
Treat obesity

This review provides an overview of serotonin (5-HT) receptor pharmacology, focusing on the roles of 5-HT receptors in various physiological functions and neuropsychiatric disorders. It also discusses two recent subtype-selective drugs: lorcaserin (targets 5-HT2C) for obesity and pimavanserin (targets 5-HT2A) for Parkinson's disease psychosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

18.

Pimavanserin for the treatment of Parkinson's disease psychosis.

Author: FriedmanJoseph H

Psychotic symptoms

This paper discusses the challenges of treating psychotic symptoms, particularly hallucinations and delusions, in patients with Parkinson's disease. Current treatment options have significant drawbacks, highlighting the need for effective and safe treatments for these debilitating side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

Inverse agonism and its therapeutic significance.

Author: KhilnaniGurudas, KhilnaniAjeet Kumar

Inverse agonism
New drug development

Inverse agonists, which bind with constitutively active receptors and reduce activity, are increasingly recognized as having therapeutic potential.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

20.

Pimavanserin, a serotonin(2A) receptor inverse agonist, for the treatment of parkinson's disease psychosis.

Author: MeltzerHerbert Y, MillsRoger, RevellStephen, WilliamsHilde, JohnsonAnn, BahrDaun, FriedmanJoseph H

PDP treatment
Motoric worsening
Non-motoric side effects

Pimavanserin, a selective 5-HT(2A) inverse agonist, was found to be well-tolerated and may be an effective treatment for psychosis in patients with Parkinson's disease. Pimavanserin did not worsen motor function or cause sedation or hypotension.

Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

21.

ACP-103, a 5-hydroxytryptamine 2A receptor inverse agonist, improves the antipsychotic efficacy and side-effect profile of haloperidol and risperidone in experimental models.

Author: GardellLuis R, VanoverKimberly E, PoundsLinda, JohnsonRobert W, BaridoRichard, AndersonGary T, VeinbergsIsaac, DyssegaardAgnete, BrunmarkPer, TabatabaeiAli, DavisRobert E, BrannMark R, HacksellUli, BonhausDouglas W

Antipsychotic efficacy
Reduced D2 receptor side effects

This study investigated the effects of a novel selective 5-HT(2A) receptor inverse agonist, ACP-103, in various models of antipsychotic activity. The study found that ACP-103 exhibited antipsychotic-like effects in these models and attenuated side effects associated with D(2) receptor antagonism, suggesting that it may be a promising adjunctive therapy for schizophrenia.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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