What is the appropriate starting dose of Austedo (dextromethorphan/bupropion)?

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Last updated: November 11, 2026 • View editorial policy

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Starting Dose of Austedo

Start Austedo at 12 mg per day (either 12 mg once daily for Austedo XR or 6 mg twice daily for standard Austedo tablets), then titrate weekly by 6 mg/day increments based on symptom control and tolerability, up to a maximum of 48 mg/day. 1

Initial Dosing Regimen

The FDA-approved starting approach is straightforward:

  • Austedo XR (extended-release): Begin with 12 mg once daily
  • Austedo (immediate-release): Begin with 6 mg twice daily (total 12 mg/day)

Both formulations deliver the same total daily dose but differ in administration frequency 1.

Titration Strategy

Weekly dose escalation is the standard approach:

  • Increase by 6 mg/day increments each week
  • Base increases on two factors: reduction of chorea/tardive dyskinesia AND tolerability
  • Maximum recommended dose: 48 mg/day
  • Most patients in clinical trials for tardive dyskinesia averaged 38.3 mg/day at optimal dosing 1

Critical Dosing Modifications

Reduce maximum dose to 36 mg/day in these situations:

  • Patients taking strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) 1
  • Poor CYP2D6 metabolizers 1

For patients with renal/hepatic impairment: The label does not provide specific dose adjustments, but caution is warranted given the drug's metabolism.

Administration Pearls

  • Austedo XR: Take with or without food; swallow whole (do not crush, chew, or break)
  • Standard Austedo: Take WITH food; swallow whole; doses ≥12 mg/day must be split into twice-daily dosing 1

Switching from Tetrabenazine

If converting from tetrabenazine, use this conversion table 1:

  • Tetrabenazine 12.5 mg → Austedo 6 mg once daily
  • Tetrabenazine 25 mg → Austedo 12 mg once daily (or 6 mg twice daily)
  • Tetrabenazine 50 mg → Austedo 24 mg once daily (or 12 mg twice daily)
  • Continue pattern: essentially divide tetrabenazine dose by approximately 2

Treatment Interruption

Less than 1 week off: Resume at previous maintenance dose without re-titration

Greater than 1 week off: Re-titrate from the beginning (start at 12 mg/day) 1

Common Pitfall

The evidence provided includes extensive information about bupropion/dextromethorphan (Auvelity) for depression, which is completely unrelated to Austedo (deutetrabenazine). Austedo is a VMAT2 inhibitor for movement disorders (Huntington's chorea and tardive dyskinesia), not an antidepressant. Do not confuse these medications.

Black Box Warning Consideration

Monitor closely for depression and suicidality, particularly in Huntington's disease patients. Austedo is contraindicated in patients who are actively suicidal or have untreated/inadequately treated depression 1. Screen for psychiatric history before initiating therapy.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.