Don't forget about clozapine for Parkinson's hallucinations and paranoia: The Living with Parkinson's Tip of the Day

Though not everyone with Parkinson’s will experience hallucinations, delusions and paranoia— it is important to be ready to treat these symptoms if they emerge.

Here are some tips:

• Once you have simplified the medication regimen, checked for urinary infections and other causes of psychosis it may be time to consider a medication treatment.

• There are really only three drugs which may help and usually will not lead to worsened parkinsonism symptoms- quetiapine (seroquel), pimavanserin (Nuplazid), and clozapine (clozaril).

• Many people discount clozapine, but in our experience it should be strongly considered if the other two drugs fail to adequately control symptoms.

• The doses of clozapine required are far less than other disorders like schizophrenia— In some cases a night-time dose of 6.25 or 12.5mg may be enough to help sleep and to alleviate hallucinations, delusions or paranoia. Some folks will of course need to titrate to higher doses.

• The main reason people reject using clozapine as it requires weekly blood monitoring— however this may be a small price to pay if it is effective.

• There is a national registry that medical professionals in the US will enroll you in for your safety called the Clozapine REMS Registry.

• We recommend to use either an experienced neurologist or alternatively to use a psychiatry office equipped to monitor the drug . Find a practice with experience in clozapine monitoring as this is important.

• We published an article about the barriers to clozapine use that may be of interest.

  Read more in the new book by Drs Okun, Malaty and Deeb: Living with Parkinson’s (Robert Rose, 2020).