Tardive dyskinesia (TD) is a movement disorder induced by long term use of dopamine blocking medications. We don’t have many available treatment options for tardive dyskinesias. Physicians are using Tetrabenzaine as off label treatment and recently Valbenazine got FDA approval for TD treatment. Also a new medication, deutetrabenazine, is currently under FDA review as potential treatment for TD.
This post will compare Tetrabenazine, Valbenazine and Deutetrabenazine.
Mechanism of Action
VMAT2 inhibitor (non selective)
VMAT2 inhibitor (highly selective)
Derivative of tetrabenazine in which two trideuteromethoxy groups substitute two methoxy groups- this results in slow breakdown of metabolite.
FDA Approved Indications
chorea associated with Huntington’s disease
Off label for TD treatment.
Adults with tardive dyskinesia
Chorea associated with Huntington’s disease
Off label for TD treatment: currently under FDA review.
Dose and Frequency
Starting dose is 12.5 mg daily; 2nd week, 25 mg (12.5 mg twice daily); may need three time dosing
Reason: Short half life.
Initial dose is 40 mg once daily. After one week, increase to recommended dose of 80 mg once daily
Half life of metabolite ~20 hr: so once daily dosing is preferred.
Dose from 24-36 mg/daily is shown to improve TD symptoms in randomized fixed dose trials.
Dosing recommendations for Huntington’s chorea: starting dose is 6 mg once daily. Titrate up at weekly intervals by 6 mg per day to a tolerated dose that reduces chorea, up to a maximum recommended daily dosage of 48 mg (24 mg twice daily).
Mood: Depression, suicidal ideations
Motor: Parkinsonism, akathisia
Patients requiring doses above 50 mg per day should be genotyped for CYP2D6 to determine if patient is a poor metabolizer or extensive metabolizer
25 mg tabs # 30 tabs: price range from ~1,500- $3,500 (out of pocket). Price may vary if approved by insurance.
40 mg caps # 30 caps: price range from ~$5,400- $5,800 (out of pocket). Price may vary if approved by insurance.
12 mg tabs # 60 tabs: price range from ~$5000- $$5270 (out of pocket). Price may vary if approved by insurance.