Should Austedo (deutetrabenazine) be taken in the morning or evening?

Austedo Administration Timing

Austedo (deutetrabenazine) should be taken twice daily—once in the morning and once in the evening—when the total daily dose is 12 mg or above, and must be administered with food. 1

Standard Dosing Schedule

For the immediate-release formulation (Austedo):

• Total daily doses of 12 mg or higher must be divided into two doses: morning and evening 1
• Each dose should be taken with food 1
• The typical starting dose is 6 mg twice daily (12 mg per day total) 1
• Doses are titrated weekly by 6 mg per day increments based on symptom control and tolerability, up to a maximum of 48 mg per day 1

For the extended-release formulation (Austedo XR):

• Administered once daily in the morning 1
• Can be taken with or without food 1
• Starting dose is 12 mg once daily 1

Rationale for Twice-Daily Dosing

The twice-daily dosing requirement for standard Austedo relates to its pharmacokinetic profile:

• Deutetrabenazine has active metabolites (α-HTBZ and β-HTBZ) with half-lives of approximately 9-10 hours 2
• The twice-daily schedule maintains more stable drug levels throughout the 24-hour period 2
• Peak-to-trough fluctuations are significantly lower with deutetrabenazine compared to its predecessor tetrabenazine (11-fold lower at steady state) 2

Practical Titration Example

The FDA-approved titration kit demonstrates the morning/evening split dosing pattern: 1

• Week 1: 6 mg every morning only
• Week 2: 6 mg every morning AND 6 mg every evening
• Week 3: 9 mg every morning AND 9 mg every evening
• Week 4: 12 mg every morning AND 12 mg every evening

Important Administration Details

Critical requirements:

• Tablets must be swallowed whole—do not chew, crush, or break 1
• Standard Austedo requires food administration to optimize absorption 1
• The extended-release formulation offers flexibility for patients who prefer once-daily dosing 1

Tolerability Considerations

While the timing is dictated by pharmacokinetics rather than side effect management:

• Somnolence is the most commonly reported adverse effect with deutetrabenazine 3, 4
• However, the overall tolerability profile is similar to placebo, with most adverse events being mild to moderate 5
• Individual neuropsychiatric adverse events typically occur in less than 7% of patients 5

The twice-daily dosing schedule for standard Austedo is not optional when doses exceed 12 mg per day—it is required per FDA labeling to maintain therapeutic drug levels and optimize efficacy for chorea control. 1