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

机译：从非标志性抗抗精神病学转换为Pimavanserin的指导，用于帕金森病理学症：专家共识

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Patients with Parkinson’s disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions. A panel of experts drew from published data, their experience treating PDP, lessons from switching antipsychotic drugs in other populations, and the pharmacology of the relevant drugs, to establish consensus recommendations. The panel concluded that patients with PDP can be safely and effectively switched from atypical antipsychotics used off label in PDP to the recently approved pimavanserin by considering each agent’s pharmacokinetics and pharmacodynamics, receptor interactions, and the clinical reason for switching (efficacy or adverse events). Final recommendations are that such a switch should aim to maintain adequate 5-HT2A antagonism during the switch, thus providing a stable transition so that efficacy is maintained. Specifically, the consensus recommendation is to add pimavanserin at the full recommended daily dose (34 mg) for 2–6 weeks in most patients before beginning to taper and discontinue quetiapine or clozapine over several days to weeks. Further details are provided for this recommendation, as well as for special clinical circumstances where switching may need to proceed more rapidly.
机译：患有帕金森病理学症（PDP）的患者经常用非典型抗精神病药，特别是喹硫氨酸或氯氮平治疗，但副作用，缺乏足够的疗效，或两者都可能促使切换到Pimavanserin，这是第一种批准用于PDP管理的药物。对于Pimavanserin的最佳实施方式没有明确，因为文献中没有控制试验或案例系列来提供指导。突然开关可能中断部分有效的处理或潜在地触发来自抗精神病药戒断的反弹效应，而交叉锥涉及潜在的药物相互作用。专家小组从已发表的数据中取出，他们的经验处理PDP，从其他人口切换抗精神病药物的教训，以及相关药物的药理学，建立共识建议。该小组得出结论，通过考虑每个试剂的药代动力学和药效学，受体相互作用以及切换（疗效或不良事件）的临床原因，可以安全有效地从非典型抗精神病药患者从非典型抗精神病药（PDP）中使用的非典型抗精神病药转换为最近批准的Pimavanser。最终建议是，这种开关应该旨在在开关期间保持足够的5-HT2A对抗，从而提供稳定的过渡，从而维持有效性。具体而言，共识建议是在大多数患者开始逐渐变细并在几天到几周内停止血糖或氯氮平的大多数患者在大多数患者中添加Pimavanserin 2-6周。提供了进一步的详细信息，为此推荐提供了进一步的详细信息，以及用于切换可能需要更快地进行的特殊临床环境。

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