Tapering Protocol for Ingrezza (Valbenazine) from 80 mg
The recommended approach to tapering Ingrezza (valbenazine) from 80 mg is to reduce the dose gradually by approximately 10% per month, which would mean decreasing to 40 mg daily for 4 weeks before discontinuation. 1, 2
General Principles for Medication Tapering
- Gradual tapering is preferred over abrupt discontinuation to minimize withdrawal symptoms and potential rebound effects 3, 4
- Slower tapers (10% per month rather than 10% per week) are better tolerated, especially for medications affecting neurological function 4
- Monitoring for withdrawal symptoms after each dose reduction is essential before proceeding to the next step 5
Specific Ingrezza Tapering Protocol
- Step 1: Reduce from 80 mg to 40 mg daily (50% reduction) 6
- Step 2: Maintain 40 mg daily for approximately 4 weeks to allow neuroadaptation 1
- Step 3: Discontinue after the 4-week period at 40 mg 6, 7
Rationale for This Approach
- Valbenazine is a VMAT2 inhibitor that affects dopaminergic neurotransmission, requiring gradual reduction to allow neuroadaptation 6, 7
- The 40 mg dose represents a clinically effective dose (effect size d=0.52) that can serve as an appropriate intermediate step during discontinuation 6
- This two-step approach balances the need for gradual tapering with the practical limitations of available dosage forms 7
Monitoring During Tapering
- Monitor for return of tardive dyskinesia symptoms, which may indicate the need to slow the taper or return to a higher dose 4, 1
- Assess for withdrawal symptoms such as anxiety, insomnia, or worsening movement disorders at each follow-up 4
- If significant symptoms emerge during the taper, consider extending the time at 40 mg before complete discontinuation 4, 2
Special Considerations
- For patients with hepatic impairment, the taper may need to be more gradual, as valbenazine metabolism is affected 7
- Patients taking strong CYP3A4 inhibitors or inducers may require adjusted tapering schedules due to altered drug metabolism 7
- Document baseline tardive dyskinesia severity before beginning taper to better assess any symptom recurrence 6
Common Pitfalls to Avoid
- Tapering too quickly can lead to withdrawal symptoms or rapid recurrence of tardive dyskinesia 4, 1
- Failing to monitor for symptom recurrence during and after the taper 4
- Not having a contingency plan if symptoms worsen significantly during the taper 4, 2
This tapering protocol aligns with general principles for medication discontinuation while accounting for valbenazine's specific pharmacological properties as a VMAT2 inhibitor used in the treatment of tardive dyskinesia.