Nuplazid is a specific drug for the treatment of Parkinson's disease and psychiatric disorders. It is necessary to strictly control the indications and pay attention to cardiovascular and metabolic risk monitoring.

1. Indications

(1) Core indications

The US FDA has approved the use for hallucinations and delusions related to Parkinson's disease, but not for non Parkinson's or dementia related mental illnesses.

(2) Applicable population characteristics

Diagnosis of Parkinson's disease with moderate to severe psychiatric symptoms (SAPS or NPI score ≥ 4) is required, and medication triggering factors must be excluded before use.

2. Absolute contraindications

(1) Abnormal cardiac conduction

Patients with a history of QT interval prolongation or baseline QTc>450ms are contraindicated as the medication may further prolong the QT interval and increase the risk of apical torsion ventricular tachycardia.

(2) Severe liver injury

Child Pugh C grade liver dysfunction patients are contraindicated as metabolic disorders can lead to drug accumulation, increasing the incidence of adverse reactions by more than three times.

3. Relative contraindications

(1) Drug interactions

It is prohibited to use it in combination with potent CYP3A4 inhibitors (such as ketoconazole and clarithromycin), as it can increase the blood concentration of pimavanserin by 5 times, and alternative antipsychotic drugs need to be used instead.

(2) Neurological disorders

Patients with severe dementia and abnormal mental behavior should use caution. Clinical trials have shown that the mortality rate may increase in this population, and the benefit risk ratio needs to be evaluated.

(3) Metabolic abnormalities

Uncontrolled hypokalemia or hypomagnesemia patients should correct electrolytes before medication to avoid exacerbating the risk of QT interval prolongation.

(4) Allergy history

Individuals with a history of hypersensitivity reactions to pimofonserin or its excipients (such as lactose) are prohibited from using it, as it may cause vascular edema or severe rash.

4. Medication precautions

(1) Cardiovascular monitoring

Regular electrocardiogram monitoring of QT interval is required before and during treatment. Patients with baseline QTc>450ms are prohibited from using it in combination with drugs that prolong QT interval.

(2) Metabolic interactions

The dosage of CYP3A4 strong inhibitor needs to be adjusted to 17mg qd, and the dosage of strong inducer may need to be increased to 34mg bid. Blood drug concentration should be rechecked 2 weeks after adjustment.