What is the starting dose of Ingrezza (valbenazine) for treating tardive dyskinesia?

Starting Dose of Ingrezza (Valbenazine) for Tardive Dyskinesia

The initial dosage of Ingrezza (valbenazine) for treating tardive dyskinesia is 40 mg once daily for one week, followed by an increase to the recommended dosage of 80 mg once daily. 1

Dosing Protocol

The FDA-approved dosing schedule for Ingrezza in tardive dyskinesia follows a simple two-step approach:

1. Initial dose: 40 mg once daily
2. After one week: Increase to 80 mg once daily (recommended maintenance dose)
3. Alternative maintenance doses: 40 mg or 60 mg once daily may be considered depending on response and tolerability

Special Populations Requiring Dose Adjustments

Certain patient populations require dose modifications:

• Moderate to severe hepatic impairment (Child-Pugh score 7-15): Maintain at 40 mg once daily
• Known CYP2D6 poor metabolizers: Maintain at 40 mg once daily
• Patients taking strong CYP3A4 inhibitors: Maintain at 40 mg once daily
• Patients taking strong CYP2D6 inhibitors: Maintain at 40 mg once daily

Administration Guidelines

• Can be taken with or without food
• Available as standard capsules (Ingrezza) or sprinkle capsules (Ingrezza Sprinkle)
• Ingrezza Sprinkle can be opened and sprinkled over soft food (applesauce, yogurt, or pudding)

Clinical Efficacy Considerations

Valbenazine is a vesicular monoamine transporter 2 (VMAT2) inhibitor specifically approved for tardive dyskinesia. Clinical trials have demonstrated:

• The 80 mg/day dose shows greater efficacy (effect size d=0.90-0.94) compared to the 40 mg/day dose (effect size d=0.52-0.55) 2, 3
• Number needed to treat (NNT) for 50% improvement in AIMS score: 4 for 80 mg dose vs. 9 for 40 mg dose 3

Important Monitoring and Safety Considerations

• Monitor for somnolence/sedation, which is the most common adverse reaction (≥5% and twice the rate of placebo) 1
• Unlike traditional antipsychotics, valbenazine has a lower risk of causing extrapyramidal symptoms or worsening tardive dyskinesia 4
• If discontinuing treatment, be aware that TD symptoms typically return toward baseline levels within 4 weeks after stopping the medication 3

Common Pitfalls to Avoid

1. Starting at too high a dose: Always start with 40 mg for one week before increasing to 80 mg
2. Failing to adjust dose in special populations: Patients with hepatic impairment or taking certain medications require the lower 40 mg dose
3. Overlooking drug interactions: Concomitant use with strong CYP3A4 inducers is not recommended
4. Abrupt discontinuation: TD symptoms typically return when medication is stopped

Valbenazine represents a significant advancement in TD treatment as it was the first FDA-approved medication specifically for this condition, offering once-daily dosing with clinically meaningful efficacy.