tetrabenazine (Rx)

Brand and Other Names:Xenazine

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 12.5mg
  • 25mg

Huntington Disease

Indicated for treatment of chorea associated with Huntington’s disease

Individualize and slowly titrate dosage over several weeks to identify a dose that reduces chorea and is well tolerated

Total daily dose up to 50 mg/day

  • 12.5 mg PO qDay initially; after 1 week, the dose should be increased to 12.5 mg q12hr
  • Maintenance: Titrate slowly by weekly intervals of 12.5 mg/day to identify dose that reduces chorea and is tolerated
  • If daily dose is 37.5 to 50 mg/day, administer in divided doses q8hr
  • Not to exceed 25 mg per single dose for total daily dosage between 37.5-50 mg/day

Total Daily dose >50 mg/day

  • If >50 mg/day is required, test and genotype to determine if poor or extensive metabolizers of CYP2D6; not to exceed 100 mg/day or 37.5 mg/dose
  • Dose maintenance requirements are dependent on CYP2D6 genotype (see Dosage Modifications)

Dosage Modifications

CYP2D6 extensive/intermediate metabolizers

  • Extensive metabolizers may require dose >50 mg/day
  • If total daily dose >50 mg/day, administer in divided doses q8hr
  • Titrate slowly by 12.5 mg/day qWeek to identify dose that reduces chorea and is tolerated
  • If >50 mg/day is required, do not to exceed 37.5 mg per single dose or a total daily dose of 100 mg/day

CYP2D6 poor metabolizers

  • Not to exceed 25 mg per single dose or a total daily dose of 50 mg/day

Hepatic impairment

  • Contraindicated; it is not possible to adjust the dose to ensure safe use

Dosing Considerations

May take with or without food

Dosage interruption >5 days: Retitrate dose when treatment resumed

Dosage interruption <5 days: May resume at previous maintenance dose without titration

Suspend upward dosage titration and reduce dose; discontinue if adverse reaction (intolerable effects such as: akathisia, restlessness, parkinsonism, insomnia, depression, suicidality, anxiety, sedation) does not resolve (may stop without taper)

Treatment discontinuation

  • May discontinue without tapering
  • Chorea may re-emerge within 12-18 hr after last dose

Tardive Dyskinesia (Off-label)

Investigational (see www.clinicaltrials.gov)

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and tetrabenazine

No Results

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      Serious - Use Alternative

        Significant - Monitor Closely

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             activity indicator 

            Contraindicated (15)

            • deutetrabenazine

              tetrabenazine, deutetrabenazine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Do not use these drugs concomitantly. Deutetrabenazine may be initiated the day after discontinuing tetrabenazine.

            • dronedarone

              tetrabenazine and dronedarone both increase QTc interval. Contraindicated.

            • goserelin

              goserelin increases toxicity of tetrabenazine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • isocarboxazid

              tetrabenazine, isocarboxazid. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • leuprolide

              leuprolide increases toxicity of tetrabenazine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • linezolid

              tetrabenazine, linezolid. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • phenelzine

              tetrabenazine, phenelzine. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • procarbazine

              tetrabenazine, procarbazine. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • quinidine

              tetrabenazine and quinidine both increase QTc interval. Contraindicated.

            • rasagiline

              tetrabenazine, rasagiline. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. .

            • selegiline

              tetrabenazine, selegiline. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode; separate by 14 days. Mechanism: MAOI causes accumulation of norepinephrine in neuron and tetrabenazine stimulates norepinephrine release.

            • selegiline transdermal

              tetrabenazine increases effects of selegiline transdermal by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode; separate by 14 days. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • thioridazine

              tetrabenazine and thioridazine both increase QTc interval. Contraindicated.

            • tranylcypromine

              tetrabenazine, tranylcypromine. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • valbenazine

              tetrabenazine, valbenazine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Do not use these drugs concomitantly.

            Serious - Use Alternative (138)

            • adagrasib

              adagrasib, tetrabenazine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

            • alfuzosin

              alfuzosin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • amiodarone

              tetrabenazine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

            • amisulpride

              amisulpride and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

            • anagrelide

              anagrelide and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • apomorphine

              apomorphine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • aripiprazole

              aripiprazole and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              tetrabenazine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              tetrabenazine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine

              asenapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine transdermal

              asenapine transdermal and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • atomoxetine

              atomoxetine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • bedaquiline

              bedaquiline and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen and tetrabenazine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • buprenorphine

              buprenorphine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine buccal

              buprenorphine buccal and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine subdermal implant

              buprenorphine subdermal implant and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

              buprenorphine subdermal implant and tetrabenazine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • buprenorphine transdermal

              buprenorphine transdermal and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

              buprenorphine transdermal and tetrabenazine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • buprenorphine, long-acting injection

              buprenorphine, long-acting injection and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ceritinib

              ceritinib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • chlorpromazine

              tetrabenazine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

            • citalopram

              citalopram and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • clozapine

              clozapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • crizotinib

              crizotinib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • dasatinib

              dasatinib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • degarelix

              degarelix and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • desflurane

              desflurane and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • disopyramide

              tetrabenazine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

            • dofetilide

              dofetilide increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.

            • dolasetron

              dolasetron and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • donepezil

              donepezil and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              tetrabenazine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • efavirenz

              efavirenz and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • eliglustat

              eliglustat and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

            • entrectinib

              tetrabenazine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • eribulin

              eribulin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

            • erythromycin base

              tetrabenazine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              tetrabenazine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              tetrabenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              tetrabenazine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

            • escitalopram

              escitalopram increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • fingolimod

              fingolimod and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • flecainide

              tetrabenazine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

            • fluconazole

              tetrabenazine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • fluoxetine

              tetrabenazine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • fluphenazine

              tetrabenazine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • fluvoxamine

              tetrabenazine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.

            • foscarnet

              tetrabenazine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

            • gemifloxacin

              tetrabenazine and gemifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • gemtuzumab

              tetrabenazine and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.

            • gilteritinib

              gilteritinib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              tetrabenazine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • granisetron

              granisetron and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • haloperidol

              tetrabenazine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • histrelin

              histrelin increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxyzine

              hydroxyzine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              tetrabenazine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • iloperidone

              tetrabenazine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              inotuzumab and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • iobenguane I 131

              tetrabenazine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • isoflurane

              isoflurane and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • itraconazole

              tetrabenazine and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              tetrabenazine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

            • lapatinib

              tetrabenazine and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • levofloxacin

              tetrabenazine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • lithium

              lithium and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • loperamide

              tetrabenazine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

            • lopinavir

              tetrabenazine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              tetrabenazine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.

            • maprotiline

              tetrabenazine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

            • mefloquine

              mefloquine increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • methadone

              tetrabenazine and methadone both increase QTc interval. Avoid or Use Alternate Drug.

            • metoclopramide intranasal

              tetrabenazine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • midostaurin

              tetrabenazine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

            • mifepristone

              tetrabenazine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.

            • mirtazapine

              mirtazapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • mobocertinib

              mobocertinib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • moxifloxacin

              tetrabenazine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nilotinib

              tetrabenazine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • octreotide

              tetrabenazine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • ofloxacin

              tetrabenazine and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • olanzapine

              olanzapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • olopatadine intranasal

              tetrabenazine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • ondansetron

              tetrabenazine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.

            • osimertinib

              tetrabenazine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.

            • oxaliplatin

              oxaliplatin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • paliperidone

              tetrabenazine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              tetrabenazine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • paroxetine

              tetrabenazine and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • pasireotide

              tetrabenazine and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.

            • pazopanib

              tetrabenazine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • pentamidine

              tetrabenazine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • perphenazine

              tetrabenazine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • pimavanserin

              pimavanserin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

            • pimozide

              tetrabenazine and pimozide both increase QTc interval. Contraindicated.

            • pitolisant

              tetrabenazine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • posaconazole

              tetrabenazine and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              tetrabenazine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • prochlorperazine

              tetrabenazine and prochlorperazine both decrease QTc interval. Avoid or Use Alternate Drug.

            • promethazine

              tetrabenazine and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.

            • propafenone

              tetrabenazine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

            • quetiapine

              tetrabenazine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.

            • quinine

              tetrabenazine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

            • ranolazine

              tetrabenazine and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ribociclib

              ribociclib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • rilpivirine

              tetrabenazine and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.

            • risperidone

              tetrabenazine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • romidepsin

              tetrabenazine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

            • ropeginterferon alfa 2b

              ropeginterferon alfa 2b and tetrabenazine both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.

            • safinamide

              tetrabenazine decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

            • saquinavir

              tetrabenazine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • sertraline

              sertraline and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • sevoflurane

              sevoflurane and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              siponimod and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • solifenacin

              solifenacin and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • sorafenib

              tetrabenazine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • sotalol

              tetrabenazine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • sunitinib

              sunitinib and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • tacrolimus

              tacrolimus and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • telavancin

              tetrabenazine and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

            • thiothixene

              tetrabenazine and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.

            • toremifene

              tetrabenazine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.

            • trazodone

              tetrabenazine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

            • trifluoperazine

              tetrabenazine and trifluoperazine both decrease QTc interval. Avoid or Use Alternate Drug.

            • triptorelin

              triptorelin increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

            • vandetanib

              tetrabenazine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.

            • vardenafil

              tetrabenazine and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.

            • vemurafenib

              tetrabenazine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • venlafaxine

              tetrabenazine and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.

            • voriconazole

              tetrabenazine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • vorinostat

              vorinostat and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ziprasidone

              tetrabenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (73)

            • abiraterone

              abiraterone increases levels of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

            • acrivastine

              acrivastine and tetrabenazine both increase sedation. Use Caution/Monitor.

            • albuterol

              albuterol and tetrabenazine both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              tetrabenazine and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • amisulpride

              amisulpride and tetrabenazine both increase sedation. Use Caution/Monitor.

            • amitriptyline

              tetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.

            • amoxapine

              amoxapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • arformoterol

              arformoterol and tetrabenazine both increase QTc interval. Use Caution/Monitor.

            • aripiprazole

              aripiprazole and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • asenapine

              asenapine and tetrabenazine both increase sedation. Use Caution/Monitor.

            • asenapine transdermal

              asenapine transdermal and tetrabenazine both increase sedation. Use Caution/Monitor.

            • avapritinib

              avapritinib and tetrabenazine both increase sedation. Use Caution/Monitor.

            • brexanolone

              brexanolone, tetrabenazine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brexpiprazole

              brexpiprazole and tetrabenazine both increase sedation. Use Caution/Monitor.

            • brimonidine

              brimonidine and tetrabenazine both increase sedation. Use Caution/Monitor.

            • brivaracetam

              brivaracetam and tetrabenazine both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, tetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • ciprofloxacin

              ciprofloxacin and tetrabenazine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • clobazam

              tetrabenazine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              tetrabenazine and clomipramine both increase QTc interval. Use Caution/Monitor.

            • clozapine

              clozapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • daridorexant

              tetrabenazine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • desipramine

              tetrabenazine and desipramine both increase QTc interval. Use Caution/Monitor.

            • difelikefalin

              difelikefalin and tetrabenazine both increase sedation. Use Caution/Monitor.

            • doxepin

              tetrabenazine and doxepin both increase QTc interval. Use Caution/Monitor.

            • droperidol

              droperidol and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • esketamine intranasal

              esketamine intranasal, tetrabenazine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • fluoxetine

              fluoxetine increases effects of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decrease tetrabenazine dose by 50% when coadministered with strong CYP2D6 inhibitors.

            • fluphenazine

              fluphenazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • fostemsavir

              tetrabenazine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • ganaxolone

              tetrabenazine and ganaxolone both increase sedation. Use Caution/Monitor.

            • haloperidol

              haloperidol and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • iloperidone

              iloperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • imipramine

              tetrabenazine and imipramine both increase QTc interval. Use Caution/Monitor.

            • isradipine

              tetrabenazine and isradipine both increase QTc interval. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, tetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant will increase the level or effect of tetrabenazine by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • lenvatinib

              tetrabenazine and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • lofexidine

              tetrabenazine and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.

            • loxapine

              loxapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • loxapine inhaled

              loxapine inhaled and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • lurasidone

              lurasidone, tetrabenazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • metoclopramide

              metoclopramide and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • midazolam intranasal

              midazolam intranasal, tetrabenazine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • nortriptyline

              tetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              olanzapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • osilodrostat

              osilodrostat and tetrabenazine both increase QTc interval. Use Caution/Monitor.

            • oxaliplatin

              oxaliplatin will increase the level or effect of tetrabenazine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • ozanimod

              ozanimod and tetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

              paliperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • paroxetine

              paroxetine increases effects of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decrease tetrabenazine dose by 50% when coadministered with strong CYP2D6 inhibitors.

            • perphenazine

              perphenazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • pimozide

              pimozide and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • prochlorperazine

              prochlorperazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • promethazine

              promethazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • protriptyline

              tetrabenazine and protriptyline both increase QTc interval. Use Caution/Monitor.

            • quetiapine

              quetiapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • quinidine

              quinidine increases effects of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decrease tetrabenazine dose by 50% when coadministered with strong CYP2D6 inhibitors.

            • remimazolam

              remimazolam, tetrabenazine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              risperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • ritonavir

              ritonavir increases effects of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decrease tetrabenazine dose by 50% when coadministered with strong CYP2D6 inhibitors.

            • selpercatinib

              selpercatinib increases toxicity of tetrabenazine by QTc interval. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of tetrabenazine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of tetrabenazine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .

            • stiripentol

              stiripentol, tetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • thioridazine

              thioridazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • thiothixene

              thiothixene and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • triclabendazole

              triclabendazole and tetrabenazine both increase QTc interval. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • trimipramine

              tetrabenazine and trimipramine both increase QTc interval. Use Caution/Monitor.

            • voclosporin

              voclosporin, tetrabenazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • ziprasidone

              ziprasidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            Minor (3)

            • azithromycin

              azithromycin increases toxicity of tetrabenazine by QTc interval. Minor/Significance Unknown.

            • chloroquine

              chloroquine increases toxicity of tetrabenazine by QTc interval. Minor/Significance Unknown.

            • primaquine

              primaquine and tetrabenazine both increase QTc interval. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Sedation/somnolence (31%)

            Fatigue (22%)

            Insomnia (22%)

            Depression (19%)

            Akathisia (19%)

            Extrapyramidal event (15%)

            Anxiety (15%)

            Nausea (13%)

            1-10%

            Irritability (9%)

            Bruising (6%)

            Vomiting (6%)

            Decreased appetite (4%)

            Dysuria (4%)

            Obsessive reaction (4%)

            Imbalance (9%)

            Parkinsonism/bradykinesia (9%)

            Dizziness (4%)

            Dysarthria (4%)

            Unsteady gait (4%)

            Headache (4%)

            Frequency Not Defined

            QTc prolongation

            Neuroleptic malignant syndrome

            Orthostatic Hypotension

            Restlessness and agitation

            Dysphagia

            Depression and suicidality

            Postmarketing Reports

            Nervous system disorders: Tremor

            Psychiatric disorders: Confusion, worsening aggression, depression/suicidality

            Respiratory, thoracic and mediastinal disorders: Pneumonia

            Skin and subcutaneous tissue disorders: Hyperhidrosis, skin rash

            Endocrine system: Hyperprolactinemia

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            Warnings

            Black Box Warnings

            Increased risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease

            Balance risks of depression and suicidality with the clinical need for control of choreiform movements when considering the use of tetrabenazine

            Monitor for emergence or worsening of depression, suicidality, or unusual changes in behavior

            Inform patients, caregivers and families of the risk of depression and suicidality and instruct to report behaviors of concern promptly to the treating physician

            Caution in patients with a history of depression or prior suicide attempts or ideation

            Contraindicated in patients who are actively suicidal, and in patients with untreated or inadequately treated depression

            Contraindications

            Hypersensitivity

            Hepatic impairment

            Patients who are actively suicidal, or who have untreated or inadequately treated depression (see Black Box Warnings)

            Coadministration with deutetrabenazine or valbenazine

            Concomitant MAO inhibitor or within 14 days of discontinuing MAO inhibitor

            Concomitant use with reserpine

            Cautions

            Not indicated for treatment of levodopa-induced dyskinetic movements

            Should only be used by physicians experienced with treatment of hyperkinetic disorders

            Induced postural dizziness reported; however, blood pressure has not been measured during such events;monitoring of vital signs on standing should be considered in patients who are vulnerable to hypotension

            Depression and suicidality

            • Patients with Huntington’s disease (HD) are at increased risk for depression, suicidal ideation or behaviors (suicidality); this drug increases risk for suicidality in patients with HD
            • When considering therapy, the risk of suicidality should be balanced against need for treatment of chorea; all patients should be observed for new or worsening depression or suicidality; if depression or suicidality does not resolve, consider discontinuing treatment
            • Patients, their caregivers, and families should be informed of risks of depression, worsening depression, and suicidality associated with therapy, and should be instructed to report behaviors of concern promptly to treating physician; patients with HD who express suicidal ideation should be evaluated immediately

            Clinical worsening and adverse effects

            • Huntington’s disease is a progressive disorder characterized by changes in mood, cognition, chorea, rigidity, and functional capacity over time; overtime also caused slight worsening in mood, cognition, rigidity, and functional capacity
            • Whether these effects persist, resolve, or worsen with continued treatment is unknown; prescribers should periodically reevaluate need for therapy by assessing effect on chorea and possible adverse effects, including depression and suicidality, cognitive decline, parkinsonism, dysphagia, sedation/somnolence, akathisia, restlessness, and disability
            • It may be difficult to distinguish between adverse reactions and progression of underlying disease; decreasing the dose or stopping the drug may help the clinician distinguish between the two possibilities; in some patients, underlying chorea itself may improve over time, decreasing the need for therapy

            Poor and extensive metabolizers

            • Before prescribing a daily dose that is greater than 50 mg per day, patients should be genotyped to determine if they express the drug metabolizing enzyme, CYP2D6; CYP2D6 testing is necessary to determine whether patients are poor metabolizers (PMs), extensive (EMs) or intermediate metabolizers (IMs) of this drug
            • Patients who are PMs will have substantially higher levels of the primary drug metabolites (about 3-fold for α-HTBZ and 9-fold for β-HTBZ) than patients who are Ems; the dosage should be adjusted according to patient’s CYP2D6 metabolizer status; in patients who are identified as CYP2D6 PMs, the maximum recommended total daily dose is 50 mg and the maximum recommended single dose is 25 mg

            Neuroleptic malignant syndrome (NMS)

            • A potentially fatal symptom complex sometimes referred to as neuroleptic malignant syndrome (NMS) has been reported in association with the drug and other drugs that reduce dopaminergic transmission
            • Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia); additional signs may include elevated creatinine phosphokinase, myoglobinuria, rhabdomyolysis, and acute renal failure
            • The diagnosis of NMS can be complicated; other serious medical illnesses (eg, pneumonia, systemic infection), and untreated or inadequately treated extrapyramidal disorders can present with similar signs and symptoms
            • Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system pathology
            • The management of NMS should include immediate discontinuation of the drug, intensive symptomatic treatment and medical monitoring; and treatment of any concomitant serious medical problems for which specific treatments are available
            • There is no general agreement about specific pharmacological treatment regimens for NMS; recurrence of NMS has been reported with resumption of drug therapy; if treatment is needed after recovery from NMS, patients should be monitored for signs of recurrence

            Parkinsonism

            • Therapy may cause parkinsonism; because rigidity can develop as part of underlying disease process in Huntington’s disease, it may be difficult to distinguish between this drug-induced adverse reaction and progression of the underlying disease process
            • Drug-induced parkinsonism has the potential to cause more functional disability than untreated chorea for some patients with Huntington’s disease; if a patient develops parkinsonism during treatment, dose reduction should be considered; in some patients, discontinuation of therapy may be necessary

            Sedation and somnolence

            • Sedation is the most common dose-limiting adverse reaction of this drug; in clinical trials, sedation was the reason upward titration was stopped and/or the dose decreased; in some patients, sedation has occurred at doses lower than recommended doses
            • Patients should not perform activities requiring mental alertness to maintain safety of themselves or others, such as operating a motor vehicle or operating hazardous machinery, until they are on a maintenance dose and know how the drug affects them

            QTc prolongation

            • The drug causes a small increase (about 8 msec) in corrected QT (QTc) interval; QT prolongation can lead to development of torsade de pointes-type ventricular tachycardia with risk increasing as degree of prolongation increases
            • Use of this drug should be avoided in combination with other drugs known to prolong QTc, including antipsychotic medications (eg, chlorpromazine, haloperidol, thioridazine, ziprasidone), antibiotics (eg, moxifloxacin), Class 1A (eg, quinidine, procainamide), and Class III (eg, amiodarone, sotalol) antiarrhythmic medications or any other medications known to prolong the QTc interval
            • The drug should be avoided in patients with congenital long QT syndrome and in patients with a history of cardiac arrhythmias; certain circumstances may increase risk of occurrence of torsade de pointes and/or sudden death in association with use of drugs that prolong the QTc interval, including bradycardia, hypokalemia or hypomagnesemia, concomitant use of other drugs that prolong the QTc interval, and presence of congenital prolongation of the QT interval

            Hyperprolactinemia

            • Therapy elevates serum prolactin concentrations in humans; peak plasma prolactin levels have increased after administration of the drug; although amenorrhea, galactorrhea, gynecomastia, and impotence can be caused by elevated serum prolactin concentrations, the clinical significance of elevated serum prolactin concentrations for most patients is unknown
            • Chronic increase in serum prolactin levels (although not evaluated) has been associated with low levels of estrogen and increased risk of osteoporosis; if there is a clinical suspicion of symptomatic hyperprolactinemia, appropriate laboratory testing should be done and consideration should be given to discontinuation of therapy

            Binding to melanin-containing tissues

            • Since the drug or its metabolites bind to melanin-containing tissues, it could accumulate in these tissues over time; this raises the possibility that the drug may cause toxicity in these tissues after extended use; neither ophthalmologic nor microscopic examination of the eye has been conducted in chronic toxicity studies in a pigmented species , such as dogs
            • Ophthalmologic monitoring in humans was inadequate to exclude possibility of injury occurring after long-term exposure; the clinical relevance of this drug binding to melanin-containing tissues is unknown
            • Although there are no specific recommendations for periodic ophthalmologic monitoring, prescribers should be aware of the possibility of long-term ophthalmologic effects

            Drug interaction overview

            • Concomitant use of neuroleptics (eg, haloperidol, chlorpromazine, risperidone, olanzapine) may cause additive effects of QTc prolongation, NMS, and extrapyramidal disorders
            • Caution with poor CYP2D6 metabolizers or drugs that inhibit CYP2D6 (eg, fluoxetine, paroxetine, quinidine); may markedly increase exposure to tetrabenazine active metabolites (alpha- and beta-HTBZ)
            • Reserpine
              • Do not use tetrabenazine and reserpine concomitantly
              • Reserpine binds irreversibly to VMAT2 and the duration of its effect is several days
              • Caution when switching from reserpine to tetrabenazine; wait for chorea to re-emerge before administering tetrabenazine to avoid overdosage and major CNS depletion of serotonin and norepinephrine
              • At least 20 days should elapse after stopping reserpine before starting tetrabenazine
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate data on the developmental risk associated with therapy in pregnant women; administration of tetrabenazine to rats throughout pregnancy and lactation resulted in an increase in stillbirths and postnatal offspring mortality

            Lactation

            There are no data on presence of tetrabenazine or metabolites in human milk, effects on breastfed infant, or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and potential adverse effects on breastfed infant or underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Reversibly inhibits human vesicular monoamine transporter type 2 (VMAT2), resulting in decreased uptake of monoamines (eg, dopamine, serotonin, norepinephrine, histamine) into synaptic vesicles and depletion of monoamine stores from nerve terminals

            This effect is similar to reserpine, but with less peripheral activity and is shorter-acting

            Absorption

            Extent of absorption is at least 75%

            Distribution

            Protein Bound: 82-85%; 59-68% (metabolites)

            Parent drug and metabolites bind to melanin-containing tissues (ie, eye, skin)

            Rapidly distributed in brain (highest binding in striatum, lowest binding in cortex)

            Metabolism

            Rapid and extensively metabolized in liver by carbonyl reductase to active metabolites

            Metabolites (active): alpha-hydroxytetrabenazine, beta-hydroxytetrabenazine

            Active metabolites are predominantly metabolized by CYP2D6

            Elimination

            Half-Life: 7 hr (alpha-hydroxytetrabenazine); 5 hr (beta-hydroxytetrabenazine)

            Excretion: 75% urine; 7-16% feces; excreted mostly as metabolites

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            12.5 mg tablet
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            12.5 mg tablet
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            12.5 mg tablet
            tetrabenazine oral
            -
            12.5 mg tablet
            tetrabenazine oral
            -
            25 mg tablet
            tetrabenazine oral
            -
            12.5 mg tablet
            tetrabenazine oral
            -
            12.5 mg tablet
            Xenazine oral
            -
            25 mg tablet
            Xenazine oral
            -
            12.5 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            tetrabenazine oral

            TETRABENAZINE - ORAL

            (TE-tra-BEN-a-zeen)

            COMMON BRAND NAME(S): Xenazine

            WARNING: Tetrabenazine can sometimes increase the risk of depression and suicidal thoughts/attempts. People with Huntington's disease are more likely to have depression and suicidal thoughts/attempts. Discuss the risks and benefits of this medication with your doctor. People who are not being treated for their depression and suicidal thoughts/attempts, or people who have ongoing symptoms of these conditions (even with medication/treatment) must not use tetrabenazine. Tell your doctor right away if you or your family/caregivers notice that you have new/worsening symptoms of depression, sadness, loss of interest in activities you used to enjoy, suicidal thoughts/attempts, or other mental/mood/behavior changes (such as new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, strong/abnormal urges, severe restlessness, very rapid speech).

            USES: 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 TO USE: Read the Medication Guide provided by your pharmacist before you start using tetrabenazine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once a day in the morning when you first start treatment. 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.

            SIDE EFFECTS: See also Warning section.Drowsiness, trouble sleeping, tiredness, dizziness, nausea, and vomiting may occur. If any of these effects last or get worse, 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 this medication has been prescribed because your doctor 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 you have any serious side effects, including: signs of increased prolactin hormone (such as enlarged breasts, abnormal breast milk production, decreased sexual ability, a change in menstrual cycle).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, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: See also Warning section.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.Before using this medication, tell your doctor or pharmacist your medical history, especially of: breast cancer, liver problems, certain heart problems (fast/slow/irregular heartbeat, QT prolongation in the EKG).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) 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 (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: valbenazine.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, metaxalone, 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.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: muscle stiffness/pain, fixed upward position of the eyeballs, sweating, dizziness, severe drowsiness.

            NOTES: Do not share this medication with others.Lab and/or medical tests may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised May 2023. Copyright(c) 2023 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.