Treatment of Parkinson's Disease Psychosis

Andrew Schleisman, PharmD Candidate 2017; Mikayla Spangler, PharmD, BCPS; Emily Knezevich, PharmD, BCPS, CDE


US Pharmacist. 2016;41(11):HS-20-HS-26. 

In This Article

Abstract and Introduction


Delusions and hallucinations in patients with Parkinson's disease, a condition known as Parkinson's disease psychosis (PDP), have historically been treated with clozapine and quetiapine because of their relatively low likelihood of worsening motor symptoms. Although clozapine is considered the drug of choice, it is underused in this population because of the need for frequent monitoring. Quetiapine, on the other hand, is generally first-line treatment despite its questionable efficacy. Consequently, in 2006, the American Academy of Neurology identified a need for the development of a novel antipsychotic with evidence of both safety and efficacy in patients with PDP. Pimavanserin, which has shown promise in clinical trials, recently became the first agent to receive FDA approval for the treatment of PDP.


Parkinson's disease (PD), which was first described in 1817 by English surgeon and apothecary James Parkinson, is a chronic, slowly progressing neurodegenerative disease that affects as many as 1 million Americans.[1,2] According to the Parkinson's Disease Foundation, as many as 60,000 Americans are diagnosed with this often-debilitating disorder each year.[2] Although it typically is not a direct cause of death, PD is associated with many complications and comorbidities that have led to increasing rates of mortality. The CDC reported that death rates for men and women with PD increased from 8.8 to 11 and from 3.9 to 4.8 per 100,000 people, respectively, from 2000 to 2013.[3]