From the Research
When discontinuing Ingrezza (valbenazine), a gradual dose reduction is generally recommended rather than abrupt discontinuation, with a suggested tapering schedule of reducing the dose by half every week, although the most recent and highest quality study specifically addressing valbenazine tapering is not available, and the provided evidence does not directly address the tapering of valbenazine. Given the lack of direct evidence on valbenizza tapering, we can consider the general principles of tapering medications associated with withdrawal symptoms, as discussed in the study on SSRI withdrawal syndrome 1, which suggests that tapering over a period of months and down to doses much lower than minimum therapeutic doses can reduce withdrawal symptoms. However, this study does not directly apply to valbenazine. The study on propranolol withdrawal mechanism 2 suggests that prolonged administration of small dose propranolol before complete withdrawal can prevent enhanced cardiac beta adrenergic sensitivity and other adverse events, but again, this does not directly apply to valbenazine. The study on tapering clonazepam in patients with panic disorder 3 recommends reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk, but this is specific to clonazepam and not directly applicable to valbenazine. Valbenazine is used to treat tardive dyskinesia, and sudden discontinuation might potentially lead to worsening of movement symptoms, as discussed in the study on valbenazine for Tardive Dyskinesia 4. During the weaning process, patients should be monitored for any return or worsening of involuntary movements. It's essential to note that this medication adjustment should always be done under medical supervision, as individual patient factors may require personalized tapering schedules. If concerning symptoms develop during the weaning process, patients should contact their healthcare provider promptly for guidance. In the absence of specific guidelines for valbenazine tapering, a cautious approach, considering the principles of tapering other medications with potential for withdrawal symptoms, would be prudent.