Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Pimavanserin(click to collapse)
1/4 selected
Pimavanserin
Nuplazid
Selective Serotonin Inverse Agonist (Atypical Antipsychotic)
FDA-approved indications
- Hallucinations and delusions associated with Parkinson's disease psychosis
Off-label uses
- Hallucinations and delusions in Lewy body dementia (theoretical; mechanism-based)
- Hallucinations in dementia of all causes (Phase 3 data; FDA rejected broader indication)
- Negative symptoms of schizophrenia adjunct (augmenting atypical antipsychotics; in trials)
MechanismSelective 5-HT2A inverse agonist/antagonist — no dopamine receptor binding
Half-life~57 hours (parent); ~200 hours (active metabolite AC-279)
Decision GuideWhen to pick each / when to consider an alternative
Pimavanserin
Consider when
- Parkinson's disease psychosis (hallucinations or delusions) — only FDA-approved option; lower mortality than other antipsychotics in PDP (Medicare cohort HR 0.78)
- Patient on dopaminergic therapy who cannot tolerate D2 blockade — zero D2 affinity (Ki >300 nM); cannot worsen parkinsonism, EPS, or tardive dyskinesia
- Psychosis in elderly PD patient where EPS, TD, or metabolic risk must be minimized — no muscarinic or histaminergic activity, weight neutral
- PD patient on complex polypharmacy — pimavanserin does not inhibit or induce CYP enzymes; no PK interaction with carbidopa/levodopa
- +1 more
Consider an alternative when
- QT prolongation risk — concomitant QT-prolonging drugs, history of arrhythmias, hypokalemia/hypomagnesemia, or congenital long QT syndrome
- Non-PD psychosis (schizophrenia, bipolar, non-PD dementia) — FDA boxed warning against use in non-PD dementia-related psychosis; no efficacy data outside PD
- Rapid symptom control or fast washout needed — 57h parent + 200h active metabolite t½; ~2 weeks to steady state and ~2 weeks for adverse effects to clear
- Severe renal impairment or ESRD — increased exposure; use with caution
- +1 more
| Axis | Pimavanserin SGA |
|---|---|
| Boxed Warnings | |
Cerebrovascular events (elderly w/ dementia) | |
| CNS | |
Akathisia / EPS | |
Cognitive dulling / anterograde amnesia | |
| Cardiac | |
QTc prolongation | |
| GI | |
Nausea / GI (general) | |
Constipation / GI hypomotility | |
| Drug-specific / distinctive axes | |
Peripheral edema only in Pimavanserin | |
Hallucination (paradoxical — treated condition worsening) only in Pimavanserin | |
Gait disturbance only in Pimavanserin | |