From the FDA Drug Label
Deutetrabenazine is a hexahydro-dimethoxybenzoquinolizine derivative and has the following chemical name: (RR, SS)-1,3,4,6,7, 11b-hexahydro-9,10-di(methoxy-d3)-3-(2-methylpropyl)-2H-benzo[a]quinolizin-2-one. The molecular formula for deutetrabenazine is C19H21D6NO3 Deutetrabenazine is a racemic mixture containing the following structures: Deutetrabenazine is a white to slightly yellow crystalline powder that is sparingly soluble in water and soluble in ethanol Deutetrabenazine is a vesicular monoamine transporter 2 (VMAT2) inhibitor for oral administration 1.
- It has a molecular weight of 323.46 and a pKa of 6.31.
- The drug is used to treat tardive dyskinesia and chorea in patients with Huntington’s disease.
- Deutetrabenazine works by depleting monoamines (such as dopamine, serotonin, norepinephrine, and histamine) from nerve terminals 1.
From the Research
Deutetrabenazine is a medication used to treat movement disorders such as chorea associated with Huntington's disease and tardive dyskinesia, and it is recommended as a first-line treatment option due to its efficacy and favorable safety profile, as demonstrated in recent studies 2, 3.
Key Points
- Deutetrabenazine works by depleting dopamine in the brain by inhibiting vesicular monoamine transporter 2 (VMAT2), which helps reduce involuntary movements.
- The typical starting dose is 6 mg once daily, gradually increasing to a target of 6-12 mg twice daily for tardive dyskinesia or up to 24 mg twice daily for Huntington's chorea, based on symptom response and tolerability.
- Patients should take it with food as this increases its absorption.
- Common side effects include sedation, dizziness, and potential worsening of depression or suicidal thoughts, particularly in those with pre-existing psychiatric conditions.
- Deutetrabenazine is a deuterated form of tetrabenazine, meaning hydrogen atoms are replaced with deuterium, which slows metabolism and allows for less frequent dosing and potentially fewer side effects than its predecessor.
Important Considerations
- Patients with liver impairment, taking strong CYP2D6 inhibitors, or with a history of depression require careful monitoring and possible dose adjustments.
- The safety profile of deutetrabenazine is similar to that of placebo, with a low incidence of serious adverse events 3.
- Deutetrabenazine has been shown to be effective in reducing symptoms of chorea and tardive dyskinesia, with a significant improvement in quality of life for patients 2, 3.
Dosage and Administration
- The recommended starting dose of deutetrabenazine for TD 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 4.
- Deutetrabenazine can be taken with or without food, but taking it with food may increase its absorption.