What treatment is recommended for a patient with drug-induced dyskinetic movements?

From the Guidelines

For drug-induced dyskinetic movements, the most effective treatment approach is to discontinue the offending medication if possible, and if not, consider switching to an atypical antipsychotic or reducing the dose, as suggested by the American Academy of Child and Adolescent Psychiatry 1. When managing drug-induced dyskinetic movements, it's crucial to prioritize the patient's overall clinical picture and the severity of the movement disorder.

• The first step is to assess the patient's current medication regimen and consider discontinuing or reducing the dose of the offending medication, as this can often alleviate the symptoms of dyskinesia.
• If discontinuation or dose reduction is not possible, switching to an atypical antipsychotic may be an effective alternative, as these medications have a lower risk of causing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotics 1.
• In some cases, anticholinergic medications like benztropine (Cogentin) or diphenhydramine (Benadryl) may be used to manage symptoms, but their use should be carefully considered due to potential side effects.
• For tardive dyskinesia specifically, FDA-approved VMAT2 inhibitors like valbenazine (Ingrezza) or deutetrabenazine (Austedo) may be effective treatment options, as they have been shown to reduce symptoms of tardive dyskinesia in clinical trials.
• Regular monitoring for improvement and side effects is essential, with dose adjustments as needed to ensure the best possible outcome for the patient.
• It's also important to note that benzodiazepines like lorazepam can provide temporary relief in acute settings, but their use should be limited due to the risk of tolerance, addiction, and other side effects 1.

From the FDA Drug Label

1. 6 Parkinsonism INGREZZA and INGREZZA SPRINKLE may cause parkinsonism. Reduce the dose or discontinue INGREZZA or INGREZZA SPRINKLE treatment in patients who develop clinically significant parkinson-like signs or symptoms.

For a patient with drug-induced dyskinetic movements, the best course of action is to reduce the dose or discontinue the offending drug, in this case, valbenazine (INGREZZA) 2.

• Discontinuation of the drug may be necessary if the patient develops clinically significant parkinson-like signs or symptoms.
• Dose reduction may be considered if the patient's symptoms are not severe.

From the Research

Treatment Options for Drug-Induced Dyskinetic Movements

• Discontinuation of the offending drug is often the first step in managing drug-induced dyskinesias, as symptoms may resolve on their own after the drug is stopped 3
• For tardive dyskinesia, which is caused by exposure to dopamine receptor blocking drugs, treatment options include:
  • Withdrawal of antipsychotic medication if clinically feasible 4
  • Switching to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine 4
  • Use of VMAT2 inhibitors, such as deutetrabenazine and valbenazine, which have been shown to be effective in reducing symptoms of tardive dyskinesia 4, 5, 6, 7

VMAT2 Inhibitors

• Deutetrabenazine and valbenazine are two VMAT2 inhibitors that have been approved for the treatment of tardive dyskinesia 5, 6, 7
• These medications work by inhibiting the vesicular monoamine transporter type 2, which helps to regulate the release of dopamine in the brain 6, 7
• Studies have shown that deutetrabenazine and valbenazine are effective in reducing symptoms of tardive dyskinesia, with response rates ranging from 33% to 50% 5, 7
• Common adverse reactions associated with these medications include nasopharyngitis, insomnia, somnolence, and akathisia 5, 7

Dosage and Administration

• The recommended starting dose of deutetrabenazine for tardive dyskinesia is 6 mg BID, administered with food, and can be increased at weekly intervals in increments of 6 mg/day to a maximum recommended daily dosage of 24 mg BID 5
• Valbenazine is typically administered at a dose of 40-80 mg per day 7
• Deutetrabenazine and valbenazine should be used with caution in patients with certain medical conditions, such as depression, and in patients who are taking certain medications, such as monoamine oxidase inhibitors 6, 7