tetrabenazine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
tetrabenazine: clinical details
Prescribing considerations
- Confirm the movement disorder and reassess benefit, tolerability, psychiatric state and concomitant medicines.
- Assess depression, suicidality, parkinsonism, swallowing difficulty, falls risk, cardiovascular history and medicines affecting QT or dopamine transmission.
- Safety and efficacy have not been established in children; renal impairment has not been studied.
- Consider CYP2D6 phenotype and strong CYP2D6 inhibitors where clinically relevant.
Contraindications and cautions
- Hypersensitivity to tetrabenazine or an excipient
- Active suicidality
- Poorly controlled clinical depression
- Breastfeeding
- Concurrent monoamine oxidase inhibitor treatment
- Any hepatic impairment
- Parkinsonism or hypokinetic-rigid syndrome
Monitoring
- Mood, behaviour, suicidal ideation and caregiver observations
- Akathisia, agitation, parkinsonism and other extrapyramidal effects
- Swallowing and aspiration risk
- Postural symptoms, balance and falls
- QT-related risk where cardiac history or interacting medicines warrant assessment
- Symptoms of hyperprolactinaemia; investigate prolactin when clinically indicated
- Clinical benefit and adverse-effect burden
Clinical pharmacology
Tetrabenazine reversibly inhibits VMAT2 and depletes presynaptic monoamines, preferentially dopamine. It is extensively metabolised to active alpha- and beta-dihydrotetrabenazine metabolites; CYP2D6 contributes to their metabolism. Metabolites are eliminated mainly in urine.
Formulation and product differences
- The selected Xenazine product is an oral, yellowish-buff scored tablet that can be divided into equal halves.
- It contains lactose monohydrate and is unsuitable for specified rare hereditary disorders of galactose metabolism or absorption.
tetrabenazine preparations and strengths
Tablet
Route: Oral
Strengths: 25 mg
tetrabenazine interactions
Check all prescribed, over-the-counter and recreational substances. Important interactions include:
Monoamine oxidase inhibitors
The combination is contraindicated because it may cause a hypertensive crisis.
Levodopa
Tetrabenazine can oppose and reduce levodopa’s effect.
Dopamine antagonists, including antipsychotics and metoclopramide
They can increase parkinsonism, other extrapyramidal effects, QT prolongation and neuroleptic malignant syndrome risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.