Tetrabenazine

Tetrabenazine treats chorea from Huntington’s disease by depleting brain dopamine. Available in 12.5 mg and 25 mg tablets, it reduces involuntary movements. Common side effects include drowsiness, depression, and anxiety, with severe risks like suicidality and neuroleptic malignant syndrome. Adjust doses for liver impairment and CYP2D6-poor metabolizers. Avoid severe depression, liver disease, and recent MAO inhibitor use. Store at room temperature, away from light and moisture. Consult healthcare providers for alternatives like deuTetrabenazine and valbenazine.

Tetrabenazine is a medication primarily used in the treatment of chorea (involuntary muscle movements) associated with Huntington’s disease. Available in tablet forms of 12.5 mg and 25 mg, it helps manage movement disorders by depleting dopamine and other monoamines in the brain. The usual starting dose of Tetrabenazine for adults and children over 18 is 12.5 mg once daily, gradually increasing to a maximum of 50 mg daily. Patients with hepatic impairment or those identified as CYP2D6 poor metabolizers may require adjusted doses.

Tetrabenazine can cause side effects ranging from temporary ones to serious ones, such as drowsiness, fatigue, insomnia, depression, and anxiety. Serious side effects include increased depression and suicidality, neuroleptic malignant syndrome (NMS), and QT prolongation. It is essential to monitor for signs of depression, suicidal thoughts, and unusual behavior during treatment.

Contraindications include severe or untreated depression, liver disease, and recent use of reserpine or MAO inhibitors. Pregnant or breastfeeding women should avoid taking this medication due to unknown risks. Interactions with other medicines, such as MAO inhibitors, antipsychotics, antidepressants, and alcohol, can lead to increased side effects. It’s crucial to inform your doctor of all your medications and supplements.

For storage, keep Tetrabenazine at room temperature, protect it from light and moisture, and keep it out of reach of children. Regular medical check-ups are required to monitor progress and adjust dosages as necessary. Tetrabenazine alternatives include deuTetrabenazine (Austedo), valbenazine (Ingrezza), haloperidol (Haldol), risperidone (Risperdal), and others. Always do it under the supervision of your healthcare specialist for personalized treatment and dosing recommendations.

• Treatment of chorea (random muscle movements) associated with Huntington’s disease

What Are the Forms & Strengths of Tetrabenazine?

Tetrabenazine comes in the form of tablets and the following dosages:

• Tablet
  • 12.5mg
  • 25mg

What Are the Recommended Dosage of Tetrabenazine?

Adults and Children Over 18 Years Old:

• Initial Dose: Start with 12.5 mg once daily.
• Adjustment: Increase by 12.5 mg every week. If tolerated, the dosage can be divided into two or three doses daily.
• Maximum Dose: Typically, the maximum dose is 50 mg per day.

Patients with Hepatic Impairment:

• Caution Required: Tetrabenazine should be used with caution and under strict medical supervision, as the dosage may need to be adjusted to avoid potential toxicity.

CYP2D6 Poor Metabolizers:

• Dose Adjustment: These patients may require a lower dose to avoid high plasma concentrations and associated side effects.

[Note: Remember, these recommendations differ from person to person. Discuss it with your healthcare expert, and they’ll adjust your dosage accordingly.]

• Take Tetrabenazine precisely as your healthcare provider prescribes.
• The typical starting dose is low and gradually increased. Your healthcare expert will adjust the dose based on your response and tolerability.
• Tetrabenazine can be taken with or without food.
• Take the medication at the exact times daily to maintain an even level in your bloodstream.
• Consistency is critical for effectiveness. If you miss a dose, take it as soon as you remember unless it’s close to the next dose.
• Alcohol can increase specific side effects of tetrabenazine.
• Report any unusual signs or side effects to your doctor promptly.
• Regular medical and laboratory appointments may be required to monitor your progress and make changes in the dosage accordingly.

[Note: Your doctor will decide the correct dosage amount for you based on your condition, following guidelines & studies on the drug. They’ll adjust it as needed over time.]

Tetrabenazine is a medication used primarily to treat movement disorders, for instance, chorea, associated with Huntington’s disease. It depletes the brain’s dopamine and other monoamines (norepinephrine, serotonin). Tetrabenazine inhibits the vesicular monoamine transporter 2 (VMAT2), which is responsible for packaging dopamine into synaptic vesicles for release into the synaptic cleft. By reducing dopamine levels, Tetrabenazine helps decrease the involuntary movements and muscle contractions that characterize disorders like Huntington’s chorea. Always consult your healthcare expert for more detailed information tailored to your condition.

Common side effects of Tetrabenazine

Tetrabenazine can cause some side effects, lasting from a few days to weeks. If these side effects persist, bother you, or become intense, it’s essential to consult your doctor or pharmacist. Common side effects of Tetrabenazine may include:

• Drowsiness/sedation
• Fatigue
• Insomnia
• Depression
• Anxiety or restlessness
• Nausea
• Dizziness
• Balance problems or unsteady gait
• Parkinsonism (slow movements, rigidity)
• Akathisia (inner restlessness and urge to move)

Serious side effects of Tetrabenazine

The following list does not include all potential serious side effects. If you experience any severe side effects while taking Tetrabenazine, contact your doctor immediately. In case of life-threatening symptoms or a medical emergency, call 911 or the emergency number in your area immediately. Tetrabenazine can cause serious side effects that include:

• Depression and Suicidality: Increased risk, particularly in patients with a history of depression.
• Neuroleptic Malignant Syndrome (NMS): Symptoms include high fever, muscle stiffness, altered mental status & autonomic dysfunction.
• Parkinsonism: Symptoms such as tremors, slow movements, and muscle stiffness.
• QT Prolongation: This can cause irregular heartbeats, which may be life-threatening.
• Severe Hypotension: Extremely low blood pressure.
• Dysphagia: Difficulty swallowing, which may lead to aspiration.

[Note: Remember, this list does not cover all possible side effects of Tetrabenazine. Always consult with your healthcare specialist for medical advice about side effects.]

Tetrabenazine can cause serious health issues, especially for specific groups. If concerned, consult your doctor or pharmacist about alternatives.

• Depression and Suicidal Thoughts: Tetrabenazine can worsen depression and suicidal ideation, particularly in Huntington’s disease patients. Regular screening by your provider is essential. If these medication symptoms occur, contact your doctor immediately; discontinuation might be necessary.
• Worsening Huntington’s Symptoms: Tetrabenazine may exacerbate Huntington’s symptoms. Periodic evaluations by your provider are necessary to ensure the medication’s efficacy and safety. Dosage adjustments or discontinuation might be needed.
• Genetic Testing: If symptoms persist beyond a 50 mg daily dose, genetic testing for a specific enzyme that metabolizes Tetrabenazine may be required. This helps determine the appropriate dose, potentially up to 100 mg daily.
• Neuroleptic Malignant Syndrome (NMS): This rare but serious condition causes high fever, stiff muscles, and confusion. If such symptoms occur, immediate medical attention is necessary.
• Movement Issues (Parkinsonism and Akathisia): Tetrabenazine can cause restlessness, tremors, and muscle stiffness. Inform your provider if these occur for dosage adjustment or discontinuation.
• QT Prolongation: This rare condition can cause life-threatening heart rhythms. Those with a history of QT prolongation or arrhythmias should avoid tetrabenazine. Seek medical help quickly if you experience chest pain or lightheadedness.
• High Prolactin Levels: Elevated prolactin can cause breast growth, milk production, and bone weakness. Contact your provider if these symptoms appear to check prolactin levels.

What Are the FDA Boxed Warning for Tetrabenazine?

• Depression and Suicidality: Tetrabenazine can increase the risk of depression and suicidal thoughts, particularly in patients with Huntington’s disease. Regular monitoring for signs of depression or suicidal ideation is essential.
• Patient Screening: Patients should be screened for a history of depression and suicidal thoughts before starting treatment. Continuous monitoring throughout the treatment is necessary.
• Discontinuation: If depression or suicidal thoughts occur, the medication may need to be discontinued, or the dosage may need to be adjusted.

• Before using tetrabenazine, inform your doctor if you have
  • Depression, emotional disorder, or mental illness.
  • History of suicidal thoughts or actions.
  • Breast cancer (past or present).
  • Heart disease or heart rhythm disorder.
  • Personal or family history of long QT syndrome.
  • Recently, had a heart attack.
• Pregnancy and Breastfeeding
  • It is unknown if Tetrabenazine harms an unborn baby. Inform your medical care specialist if you are pregnant or planning to become pregnant.
  • It is unknown if Tetrabenazine passes into breast milk or harms a nursing baby. Avoid breastfeeding while using this medication.
• Monitoring and Risks
  • Tetrabenazine may elevate the risk of depression and suicidal thoughts. Regular monitoring by your doctor and vigilance by family or caregivers for mood changes is crucial.

You should not use Tetrabenazine if you are allergic to it or any inactive ingredients or if you have:

• Severe or untreated depression
• Suicidal thoughts
• Liver disease
• Taken reserpine in the past 20 days
• An MAO inhibitor was used for 14 days (e.g., isocarboxazid, linezolid, phenelzine, selegiline, tranylcypromine).

If you miss a dose of Tetrabenazine, take it as soon as you remember. However, if it’s close to the time for your next dosage, skip the missed dose and return to your routine dosing schedule. Do not take two doses to make up for the missed one. Consistency in medication timing is essential for effective treatment, so try to take your doses simultaneously each day.

[Note: If you have missed a Tetrabenazine dosage and are unsure about the next one, immediately consult your doctor or pharmacist.]

Taking too much Tetrabenazine can lead to an overdose, potentially causing severe side effects. Symptoms of an overdose might include severe drowsiness, nausea, vomiting, sweating, tremors, confusion, and possibly hallucinations. If you or someone else has taken too much Tetrabenazine, it is crucial to seek medical attention right away or contact poison control for guidance. Prompt treatment is important to manage any adverse effects and to prevent further complications.

[Note: If you have consumed more than the recommended dosage of Tetrabenazine, get medical help right away or call the Poison Help line at 1-800-222-1222.]

• Store Tetrabenazine at room temperature, usually ranging from 20°C to 25°C.
• Protect from excessive heat and moisture. Do not store in bathrooms or near heat sources.
• Maintain Tetrabenazine in its original packaging to protect it from light.
• Always ensure the cap is tightly closed to prevent moisture from entering.
• Store the medication out of reach and in the sight of children and pets.
• Regularly check and adhere to the expiration date on the package. Do not use past this date.

[Note: Discuss with your healthcare expert regarding the proper disposal of unused medication and any questions you may have regarding its storage.]

Tetrabenazine can interact with several medications, potentially leading to serious side effects or reduced effectiveness. Some notable interactions include:

• Monoamine Oxidase Inhibitors (MAOIs): Such as phenelzine and tranylcypromine.
• Antipsychotics: Like haloperidol and chlorpromazine.
• Antidepressants: Including fluoxetine, paroxetine, and sertraline.
• CYP2D6 Inhibitors: Such as quinidine and propafenone.
• Levodopa: Used in Parkinson’s disease treatment.

What Are the Other Tetrabenazine Interactions?

Other interactions with Tetrabenazine include:

• Alcohol: Increases the risk of central nervous system depression, leading to enhanced drowsiness and dizziness.
• Sedatives and Tranquilizers: Such as benzodiazepines, can enhance sedation and motor impairment.
• Beta-Blockers: Like propranolol, it can increase the risk of side effects such as bradycardia and hypotension.
• Digoxin: Can interact, potentially leading to increased plasma concentrations of digoxin.
• St. John’s Wort: This medication may reduce the effectiveness of Tetrabenazine due to its effect on liver enzymes.

[Note: This is not a complete list of Tetrabenazine interactions. Ensure that you tell your medical expert about any prescription, over-the-counter medicines, or herbal products you’re taking.]

• Austedo (deutetrabenazine)
• Ingrezza (valbenazine)
• Haldol, Peridol (haloperidol)
• Risperdal, Perseris (risperidone)
• Zyprexa, Zydis (olanzapine)
• Klonopin, Rivotril (clonazepam)
• Gocovri, Symmetrel (amantadine)
• Serpasil (reserpine)
• Seroquel (quetiapine)
• Abilify, Aristada (aripiprazole)
• Invega, Trinza (paliperidone)
• Tiapridal, Equilium (tiapride)

[Note: Your doctor will choose the most suitable alternative for you. We strictly advise against self-diagnosis. Taking them without medical supervision may cause serious side effects.]

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