Tetrabenazine

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Generic Name: Tetrabenazine Brand Name(s): Generics only. No brands available.

Uses

What is Tetrabenazine used for?

Tetrabenazine is used to decrease the uncontrollable movements (chorea) caused by Huntington’s disease. However, it is not a cure for the disease. Reducing the chorea will help you take part in more of your normal daily activities. This medication is thought to work by decreasing the amount of certain natural substances in the brain (monoamines such as dopamine, serotonin, and norepinephrine), which are involved with nerve and muscle function. Tetrabenazine belongs to a class of drugs called monoamine depletors.

How should I take Tetrabenazine?

Take this medication by mouth with or without food, usually once a day in the morning when you first start treatment or as directed by your doctor. Your doctor may gradually increase your dose to 2 or 3 times a day over several weeks. A slow increase in your dose will help your doctor find the best dose for you while keeping side effects as low as possible.

The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

If you stop taking this drug for several days, then start taking it again, you may need to slowly increase your dose until you reach the regular dose you had been taking. Follow your doctor’s directions on how to restart treatment.

Tell your doctor if your uncontrolled movements do not improve or if they worsen.

How do I store Tetrabenazine?

Tetrabenazine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Tetrabenazine in the bathroom or the freezer. There may be different brands of Tetrabenazine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Tetrabenazine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Tetrabenazine?

Before taking tetrabenazine, tell your doctor or pharmacist if you are allergic to it; or to deutetrabenazine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: liver problems, depression that is untreated or not responding to treatment, thoughts of suicide.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: breast cancer.

Tetrabenazine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using tetrabenazine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using tetrabenazine safely.

This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Older adults may be more sensitive to the side effects of this drug, especially QT prolongation.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Tetrabenazine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Tetrabenazine. Tetrabenazine is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Tetrabenazine?

Drowsiness, trouble sleeping, tiredness, dizziness, nausea, and vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Your doctor may need to adjust your dose to reduce these side effects.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Sometimes tetrabenazine can cause side effects that are similar to the symptoms of worsening Huntington’s disease. Your doctor may need to adjust your dose to see if these side effects are due to the drug or to the disease. Tell your doctor right away if any of these serious side effects occur: mental/mood changes (such as new/worsening depression, suicidal thoughts/attempts, problems with thinking), Parkinson’s disease symptoms (such as shaking/tremors, slowed movement, loss of balance), trouble swallowing, restlessness.

Tell your doctor right away if any of these unlikely but serious side effects occur: signs of increased prolactin hormone (such as enlarged breasts, abnormal breast milk production, decreased sexual ability, a change in menstrual cycle).

Seek immediate medical attention if you have any of these rare but serious (possibly fatal) side effects: fast/irregular heartbeat, severe dizziness, fainting.

This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, signs of kidney problems (such as change in the amount of urine).

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Tetrabenazine?

Some products that may interact with this drug are: reserpine, valbenazine.

Do not take tetrabenazine while you are using reserpine. You must wait at least 20 days after stopping reserpine before you start treatment with tetrabenazine.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

Tetrabenazine is very similar to deutetrabenazine. Do not use medications containing deutetrabenazine while using tetrabenazine.

Tetrabenazine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Tetrabenazine?

Tetrabenazine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Tetrabenazine?

Tetrabenazine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Tetrabenazine.

What is the dose of Tetrabenazine for an adult?

Usual Adult Dose for Huntington Disease

-Initial Dose: 12.5 mg orally per day once in the morning; increase to 12.5 mg orally twice a day after one week.

-Maintenance Dose: Titrate up slowly at weekly intervals by 12.5 mg daily.

-Maximum Single Dose: 25 mg

Comments:

-Administer doses 37.5 mg/day or greater in a 3 times a day regimen.

-Determine CYP450 2D6 metabolizer status in patients who require doses of greater than 50 mg per day.

Use: Chorea associated with Huntington’s disease.

Liver Dose Adjustments

Use is contraindicated.

Dose Adjustments

CYP450 Poor Metabolizers:

-Maximum Single Dose: 25 mg

-Maximum Daily Dose: 50 mg

CYP450 Extensive and Intermediate Metabolizers:

-Maximum Single Dose: 37.5 mg

-Maximum Daily Dose: 100 mg

Concomitant Use with Strong CYP450 2D6 Inhibitors:

-Maximum Single Dose: 25 mg

-Maximum Daily Dose: 50 mg

Occurrence of Adverse Reaction (e.g., akathisia, restlessness, parkinsonism, depression, insomnia, anxiety, sedation): Reduce the dose and consider discontinuing this drug or initiating other treatment (e.g., antidepressants) if events do not resolve.

Treatment Interruption:

-Less than 5 days: Resume treatment at the previous maintenance dose without titration.

-Greater than 5 days: Re-titrate with therapy resumption.

Other Comments

Administration Advice:

-Individualize dosage for each patient.

-Take this drug without regard to food.

-May discontinue this drug without tapering.

Storage Requirements:

-Protect from light.

General:

-It is unlikely this drug will be of benefit if there is no improvement after 7 to 10 days at the maximum dose.

Monitoring:

-Signs and symptoms of akathisia, agitation, restlessness, new or worsening depression, suicidality

Patient Advice:

-Avoid alcohol and other sedating drugs during treatment.

What is the dose of Tetrabenazine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Tetrabenazine available?

Tetrabenazine is available in the following dosage forms and strengths:

  • Oral tablet.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Tetrabenazine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: May 10, 2018 | Last Modified: May 10, 2018

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