From the FDA Drug Label
Tetrabenazine tablets are a vesicular monoamine transporter 2 (VMAT) inhibitor indicated for the treatment of chorea associated with Huntington’s disease. The use of Tetrabenazine (Xenazine) is for the treatment of chorea associated with Huntington’s disease 1.
- Main use: Treatment of chorea
- Specific condition: Huntington’s disease
From the Research
Tetrabenazine is a medication primarily used to treat chorea associated with Huntington's disease, and its use should be prioritized based on individual patient response and tolerability, with a typical starting dose of 12.5 mg once or twice daily, gradually increased to a maximum of 100 mg per day, divided into three doses 2. The medication works by inhibiting vesicular monoamine transporter 2 (VMAT2), which reduces dopamine levels in the brain, helping to control involuntary movements. Some key points to consider when using tetrabenazine include:
- Common side effects include drowsiness, depression, and Parkinsonism-like symptoms
- Tetrabenazine is contraindicated in patients with untreated depression or suicidal thoughts
- It's essential to monitor patients for worsening depression or suicidal ideation
- As an orphan drug, it may have limited availability
- Alternative treatments for chorea include deutetrabenazine, which has a similar mechanism of action but may have a more favorable side effect profile, as suggested by a study comparing the two medications 3 Patients should be advised to avoid activities requiring mental alertness until they know how the medication affects them. A study on tetrabenazine treatment patterns and outcomes for chorea associated with Huntington's disease found that most patients received a dose of 50 mg or less, and the most common reasons for stopping upward titration were optimal chorea control, intolerability of higher doses, and reaching the maximum recommended dosage despite suboptimal chorea control 4. Another study demonstrated the efficacy and tolerability of tetrabenazine for chorea associated with Huntington's disease, with significant improvement in modified Abnormal Involuntary Movement Scale scores 5. However, a more recent study on deutetrabenazine, a deuterated form of tetrabenazine, showed that it may provide a more favorable adverse effect profile than tetrabenazine, with a similar efficacy for controlling chorea in HD patients 6. Overall, the use of tetrabenazine should be individualized and monitored closely, with consideration of alternative treatments like deutetrabenazine, to optimize patient outcomes and minimize adverse effects 3, 2, 6, 4, 5.