What is the treatment for tardive dyskinesia?

From the Guidelines

The treatment for tardive dyskinesia primarily involves discontinuing or reducing the causative medication, typically antipsychotics, when clinically feasible, and using FDA-approved VMAT2 inhibitors as first-line treatments, as recommended by the American Psychiatric Association 1.

Tardive Dyskinesia Treatment Overview

The goal of treatment is to minimize symptoms and improve quality of life, while also considering the potential risks and benefits of continuing or modifying antipsychotic therapy.

• Discontinuing or reducing the causative medication is the first step in managing tardive dyskinesia, but this may not always be possible due to the underlying psychiatric condition.
• For established tardive dyskinesia, VMAT2 inhibitors such as valbenazine, deutetrabenazine, and tetrabenazine are recommended as first-line treatments 1.

VMAT2 Inhibitors

These medications work by reducing dopamine release in the brain, which helps control the abnormal involuntary movements associated with tardive dyskinesia.

• Valbenazine is typically dosed at 40-80 mg once daily.
• Deutetrabenazine is typically dosed at 6-48 mg daily in divided doses.
• Tetrabenazine is typically dosed at 25-200 mg daily in divided doses.

Alternative Treatments

Alternative treatments, such as clonazepam, amantadine, or ginkgo biloba extract, may be considered in some cases, although the evidence supporting their efficacy is less robust 1.

Prevention and Monitoring

Prevention is crucial, and using the lowest effective dose of antipsychotics and regular monitoring for early signs of tardive dyskinesia are important strategies for minimizing the risk of developing this condition 1.

Treatment Response and Adjustments

Treatment response should be evaluated regularly, and medication adjustments made accordingly, as tardive dyskinesia can sometimes be permanent despite treatment 1.

From the FDA Drug Label

The efficacy of AUSTEDO in the treatment for tardive dyskinesia was established in two 12‑week, randomized, double-blind, placebo-controlled, multi-center trials conducted in 335 adult ambulatory patients with tardive dyskinesia caused by use of dopamine receptor antagonists The Abnormal Involuntary Movement Scale (AIMS) was the primary efficacy measure for the assessment of tardive dyskinesia severity In Study 1, the AIMS total score for patients receiving AUSTEDO demonstrated statistically significant improvement, from baseline to Week 12, of 3.3 and 3.2 units for the 36 mg and 24 mg arms, respectively, compared with 1. 4 units in placebo The efficacy of INGREZZA SPRINKLE has been established from adequate and well-controlled studies of INGREZZA for the treatment of tardive dyskinesia A randomized, double-blind, placebo-controlled trial of INGREZZA was conducted in patients with moderate to severe tardive dyskinesia as determined by clinical observation The change from baseline in the AIMS total dyskinesia score in the 80 mg INGREZZA group was statistically significantly different from the change in the placebo group

Treatment for Tardive Dyskinesia:

• Deutetrabenazine (AUSTEDO): The recommended dose is 12 mg per day, which can be increased at weekly intervals in 6 mg/day increments to a dose target of 12 mg, 24 mg or 36 mg per day.
• Valbenazine (INGREZZA): The recommended dose is 40 mg or 80 mg per day. The treatment of tardive dyskinesia with deutetrabenazine (AUSTEDO) or valbenazine (INGREZZA) has been shown to be effective in reducing the severity of involuntary movements, as measured by the Abnormal Involuntary Movement Scale (AIMS) 2 3.

From the Research

Treatment Options for Tardive Dyskinesia

The treatment of tardive dyskinesia (TD) involves several strategies, including:

• Preventing TD by following best practices for prescribing antipsychotic medication, such as limiting the prescription to specific indications, using the minimum effective dose, and minimizing the duration of therapy 4
• Withdrawing antipsychotic medication if clinically feasible, as this is the first-line management of TD 4
• Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, which may be effective in reducing TD symptoms 4

Pharmacological Interventions

Several pharmacological interventions have been studied for the treatment of TD, including:

• VMAT2 inhibitors, such as deutetrabenazine and valbenazine, which have been shown to be beneficial in reducing TD symptoms 4, 5, 6
• Deutetrabenazine, which has been approved for the treatment of TD in adults and has been shown to be effective in reducing TD symptoms with a number needed to treat (NNT) of 5 7
• Valbenazine, which has been granted breakthrough drug status for treating TD and has been shown to improve TD symptoms in clinical trials 8

Non-Pharmacological Approaches

Non-pharmacological approaches, such as manipulating the offending agent or using non-VMAT2-inhibiting medications, may also be considered for the treatment of TD 5 However, more research is needed to determine the effectiveness of these approaches.

Key Considerations

When treating TD, it is essential to consider the individual patient's symptoms, etiology, and potential side effects of medications to find the best possible treatment approach 6 Long-term studies are needed to guide the optimization of treatment, especially in real-world settings.