Tetrabenazine

Tetrabenazine treats chorea, the involuntary movements associated with Huntington disease. It reduces movements but does not cure Huntington disease or treat all of its thinking and mood symptoms. Other uses require a separate discussion with your provider.

Tetrabenazine inhibits VMAT2, a protein that packages chemical messengers into storage vesicles in nerve cells. Reducing dopamine release can lessen excessive movement, but it can also cause slowing, stiffness, and mood effects.

Movement benefit and side effects are reviewed as the dose increases. The goal is easier daily functioning with tolerable side effects, rather than eliminating every movement.

Movements may return quickly when treatment stops. Keep refill and follow-up plans current.

• Take with or without food at the times prescribed.
• Follow the gradual dose increases. Do not increase sooner because movements are still present.
• If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
• If you have missed more than five days, contact your provider before restarting. The dose needs to be built up again.

• Sleepiness or fatigue
• Restlessness, anxiety, or trouble sleeping
• Nausea
• Slowed movement, stiffness, or balance problems

Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.

Tetrabenazine carries a boxed warning for depression and suicidal thoughts or behavior in people with Huntington disease. Review mood and behavior closely, especially after starting or changing a dose.

Your provider also checks movement, swallowing, alertness, and heart-rhythm risk. CYP2D6 genetic testing is required before prescribing more than 50 mg a day. Results and interacting medicines affect the dose limit.

For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.

Do not use with active suicidal thoughts, untreated or inadequately treated depression, liver impairment, or certain interacting medicines.

Discuss previous depression, suicide attempts, heart-rhythm problems, fainting, Parkinson-like symptoms, and swallowing difficulty.

Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.

Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.

Do not combine with an MAOI; a 14-day separation is required. After reserpine, wait at least 20 days before starting tetrabenazine. These switches need provider direction.

Do not combine with deutetrabenazine or valbenazine. Strong CYP2D6 inhibitors, including fluoxetine and paroxetine, require lower dose limits.

Antipsychotics can add stiffness, restlessness, or serious movement reactions. Alcohol, sedatives, and QT-prolonging medicines add other risks.

Track practical goals such as eating, speaking, walking, and dressing.

Stand up slowly and avoid driving when drowsy or impaired.

Keep mood follow-up appointments even when movement symptoms improve.

Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.