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


PDP is a significant nonmotor manifestation of PD that presents primarily as hallucinations and delusions. Because of its complex etiology involving endogenous and exogenous factors and neurotransmitter pathways associated with the pathophysiology of both PD and psychosis, treatment options are limited. In many cases, a patient's physical and emotional stability must be balanced. The treatment of PDP should follow a stepwise approach, and the patient and his or her caregiver should be closely involved in the treatment decision. When antipsychotic therapy is indicated, to minimize the worsening of motor symptoms, emphasis should be placed on using an agent with low D2-receptor affinity. Atypical antipsychotics with this property include quetiapine and clozapine. Pimavanserin, a novel agent with proven efficacy that does not worsen motor symptoms in PDP patients, is the first drug approved for the treatment of PDP and may be an appropriate option for patients who can afford it.