Table 1. Antipsychotic and mood stabilizing medications for use in patients with PD.

Antipsychotic medications	Starting dose	Titration	Max dose	Side effects/special considerations
Quetiapine	12.5-25 mg HS	Increase by 25mg every few days as tolerated	250 mg	Monitor for orthostatic hypotention
Clozapine	12.5-25mg HS	Increase by 25mg every few days as tolerated	Once level greater than 300, unlikely to get further clinical benefit with increased dose	Monitor for orthostatic hypotentension; 1% per year risk of agranulocytosis, requires regular blood monitoring
Pimavanserin	34mg per day	None	34mg per day	FDA approved in 2016 for treating psychosis in PD
Other antipsychotic medications*				Contraindicated. Monitor carefully for worsening Parkinsonianism / neuroleptic-malignant syndrome if exposed
Mood stabilizing medications**
Lithium	150mg HS	Increase in 150-300 mg increments as tolerated	Blood level of 0.8-1.2 for treatment of mania	Commonly causes tremor which may be particularly hard for PD patients to tolerate
Valproate	250 mg HS	Increase in increments of 250-500mg as tolerated	Blood level of 85-125 for treatment of mania	May worsen Parkinsonian symptoms. May increase ammonia which can contribute to delirium

^*Movement Disorder Society practice guidelines advice against the use of other neuroleptics due to concern for safety in PD

^**Use of other anti-epileptic mood stablizers do not generally necessitate special precautions when used in PD