What precautions should be taken when administering tetanus toxoid (TT) to a patient with a history of tardive dyskinesia (TD)?

From the Guidelines

When administering tetanus toxoid (TT) to a patient with a history of tardive dyskinesia (TD), no special precautions are typically required as there is no established connection between tetanus toxoid and TD. Tetanus toxoid can be administered according to standard protocols, which typically involve a 0.5 mL intramuscular injection in the deltoid muscle for adults. The patient should be monitored for 15-30 minutes after vaccination for any immediate adverse reactions, as is standard practice with any vaccine. While TD is a movement disorder typically associated with long-term use of dopamine receptor blocking agents like antipsychotics, tetanus toxoid is a vaccine that works through a different mechanism by stimulating antibody production against tetanus toxin. The patient's TD medication regimen should be continued without interruption during vaccination. As with any patient, a thorough history of allergic reactions to previous tetanus vaccinations or components of the vaccine should be obtained before administration. If the patient is currently experiencing acute TD symptoms, ensuring they are comfortable during the injection process may require additional time or assistance with positioning. According to the recommendations of the Advisory Committee on Immunization Practices (ACIP) 1, stable neurologic conditions, such as those seen in TD, are not considered contraindications to vaccination with tetanus toxoid.

Some key points to consider when administering TT to a patient with TD include:

• Ensuring the patient is comfortable during the injection process
• Monitoring for immediate adverse reactions after vaccination
• Continuing the patient's TD medication regimen without interruption
• Obtaining a thorough history of allergic reactions to previous tetanus vaccinations or components of the vaccine
• Administering the vaccine according to standard protocols, which typically involve a 0.5 mL intramuscular injection in the deltoid muscle for adults.

It is essential to note that the benefits of vaccination should be weighed against the risks, and if the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered 1. However, in the case of tetanus toxoid and TD, there is no established connection between the two, and vaccination can proceed as usual.

From the Research

Precautions for Administering Tetanus Toxoid to Patients with Tardive Dyskinesia

• There is no direct evidence in the provided studies that specifically addresses the precautions for administering tetanus toxoid to patients with tardive dyskinesia (TD) 2, 3, 4.
• However, it is essential to consider the general guidelines for tetanus toxoid administration and the management of TD.
• Tetanus toxoid is recommended for adults only if it has been more than 10 years since their last immunization 5.
• The administration of tetanus toxoid does not provide immediate protection against the current injury, but rather protects against future injuries 5.
• Patients with TD should be closely monitored for any changes in their condition, and their treatment plan should be adjusted accordingly 3.
• Valbenazine, a reversible inhibitor of Vesicular Monoamine Transporter Type 2 (VMAT2), is approved for the treatment of TD in adults, and its use may be considered in patients with TD who require tetanus toxoid administration 2.
• It is crucial to weigh the benefits and risks of tetanus toxoid administration in patients with TD, considering their individual medical history and current treatment plan 6, 5.

Considerations for Tardive Dyskinesia Management

• Accurate and early diagnosis of TD is crucial, as the risk of permanence increases over time 3.
• Clinicians should be educated on which patients are most at risk for TD and conduct assessments through clinical examination or using a structured evaluative tool such as the Abnormal Involuntary Movement Scale (AIMS) 3.
• New treatment approaches to persistent TD are available, including the vesicular monoamine transporter-2 (VMAT2) inhibitors, deutetrabenazine and valbenazine 3, 4.