From the Guidelines
Tardive dyskinesia is best managed by discontinuing the offending medication, and if this is not possible, switching to an atypical antipsychotic or using the lowest effective dose of the current medication. The treatment of tardive dyskinesia (TD) is primarily focused on prevention and management of symptoms, as there is no specific treatment for TD other than discontinuing the medication 1. Strategies for prevention and early detection are crucial, including adequate informed consent, baseline measures of abnormal movements, and regular assessment for dyskinesias every 3 to 6 months using the Abnormal Involuntary Movement Scale (AIMS) 1.
Some studies suggest that atypical antipsychotics may have a lower risk of developing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents 1. However, the evidence provided does not support the use of specific medications such as valbenazine or deutetrabenazine for the treatment of TD.
Key points to consider in the management of TD include:
- Discontinuing the offending medication if possible
- Switching to an atypical antipsychotic or using the lowest effective dose of the current medication
- Regular monitoring for early signs of TD using the AIMS
- Preventing TD by using the lowest effective dose of antipsychotics and preferring atypical over typical antipsychotics
- Addressing TD promptly to improve quality of life and medication adherence.
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 INGREZZA or INGREZZA SPRINKLE is a prescription medicine used to treat adults with: movements in the face, tongue, or other body parts that cannot be controlled (tardive dyskinesia).
Treatment for Tardive Dyskinesia:
- Deutetrabenazine (AUSTEDO) is effective in treating tardive dyskinesia, with statistically significant improvements in AIMS total score compared to placebo 2.
- Valbenazine (INGREZZA) is also a prescription medicine used to treat adults with tardive dyskinesia 3.
- The treatment options include:
- Deutetrabenazine (AUSTEDO)
- Valbenazine (INGREZZA) It is essential to consult a healthcare provider to determine the best course of treatment for individual patients.
From the Research
Treatment Options for Tardive Dyskinesia
- Valbenazine and deutetrabenazine are FDA-approved treatments for tardive dyskinesia (TD), which are vesicular monoamine transporter type 2 (VMAT2) inhibitors 4, 5, 6, 7.
- These medications have been shown to be effective in reducing TD symptoms, and their use should be tailored to the individual patient 4, 6.
- The Abnormal Involuntary Movement Scale can be used to assess progress for each patient 4.
Management Strategies
- Preventing tardive dyskinesia is of primary importance, and clinicians should follow best practice for prescribing antipsychotic medication, including limiting the prescription for specific indications, using the minimum effective dose, and minimising the duration of therapy 5.
- The first-line management of tardive dyskinesia is the withdrawal of antipsychotic medication if clinically feasible 5.
- Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, may be effective in reducing tardive dyskinesia symptoms 5.
Medication Classes
- Various medication classes are being used for the treatment of TD, with VMAT2 inhibitors being the first FDA-approved medications 6, 7.
- Long-term studies will further guide us in how to optimize treatment, especially in the real-world setting 6.
- Non-pharmacological approaches and other non-VMAT2-inhibiting medications may also be considered for the treatment of TD 7.
Case Reports
- Valbenazine has been shown to be effective and safe in treating severe and rapid-onset TD symptoms in a clinical trial 8.