Quetiapine for Visual Hallucinations in Parkinson’s Disease

Dosing Recommendations

Visual hallucinations are extremely common in Parkinson's disease with dementia, occurring in up to 80% of patients 3
The American Academy of Neurology recommends assessing for delirium, which may present similarly to hallucinations but requires different management 4

Levodopa/carbidopa is known to worsen psychotic symptoms while improving motor symptoms, and increases in levodopa may help motor symptoms at the cost of worsening psychotic symptoms 3, 5
Administering levodopa at least 30 minutes before meals can maximize absorption and efficacy, and a protein redistribution dietary regimen can help maximize levodopa efficacy while minimizing side effects 6, 7
Quetiapine is the preferred atypical antipsychotic for Parkinson's disease psychosis, with a starting dose of 12.5 mg twice daily and a maximum dose of 200 mg twice daily 4
Avoid typical antipsychotics, such as haloperidol and fluphenazine, as they worsen motor symptoms 4

Rivastigmine has demonstrated benefit for visual hallucinations in dementia with Lewy bodies, and can improve both cognitive function and neuropsychiatric symptoms without worsening parkinsonian features 3

Monitor for worsening motor symptoms when adjusting antipsychotics, and provide education and emotional support to families and caregivers 4