➤ APA recommends that patients who have moderate to severe or disabling
tardive dyskinesia associated with antipsychotic therapy be treated with a
reversible inhibitor of the vesicular monoamine transporter2 (VMAT2). (1B)
• If no contributing etiology is identified and moderate to severe or disabling
tardive dyskinesia persists, treatment is recommended with a reversible
inhibitor of VMAT2. Treatment with a VMAT2 inhibitor can also be considered
for patients with mild tardive dyskinesia based on factors such as patient
preference, associated impairment, or effect on psychosocial functioning.
See Table for characteristics of VMAT2 inhibitors that are currently available
in the U.S.
• Deutetrabenazine or valbenazine are preferred over tetrabenazine because
of the greater evidence base supporting their use. Tetrabenazine has a
shorter half-life and greater rates of associated depression when used in the
treatment of patients with Huntington's disease.
• Other factors that may influence choice of a VMAT2 inhibitor relate
to hepatic or renal function - tetrabenazine and deutetrabenazine are
contraindicated in individuals with hepatic impairment whereas valbenazine
is not recommended for use in individuals with severe renal impairment.
Benefits
➤ In individuals with moderate to severe or disabling tardive dyskinesia
associated with antipsychotic therapy, VMAT2 inhibitors can be
associated with significant reductions in motor signs and symptoms of
tardive dyskinesia. These medications may also be effective in other
tardive syndromes.
Harms
➤ The harms of treatment with VMAT2 inhibitors include sedation and,
with tetrabenazine, extrapyramidal effects, akathisia, insomnia, anxiety,
nausea, and falls. Depression and suicidal ideas have been reported in
individuals who were administered VMAT2 inhibitors for treatment of
Huntington's disease. Such effects are possible in individuals treated for
tardive dyskinesia although they were not reported in clinical trials.
Treatment
