Fast Five Quiz: Tardive Dyskinesia Management

Christoph U. Correll, MD


June 28, 2023

Two vesicular monoamine transporter 2 (VMAT2) inhibitors have been approved by the US Food and Drug Administration for the treatment of adults with TD: valbenazine and deutetrabenazine. These drugs modulate the presynaptic packaging and release of dopamine into the synapse and may improve or offset the movement-related effects of antipsychotics and other dopaminergic blockers.

Atypical antipsychotics may be used instead of typical antipsychotics to control psychosis, and to reduce the risk for TD. Whereas typical antipsychotics primarily block dopamine D2 receptors, atypical antipsychotics bind variably to dopaminergic, serotonergic, alpha-adrenergic, histaminic, and muscarinic receptors. In particular, a switch to clozapine has been recommended as treatment for patients with TD who require antipsychotics. Clozapine is one of the most effective atypical antipsychotics for treatment-refractory schizophrenia, but it also has other adverse effects that require monitoring.

Although clozapine has been associated with TD, the incidence of TD with clozapine and other atypical antipsychotics appears to be lower compared with typical antipsychotics.

There has been anecdotal and inconsistent evidence that vitamin E (not vitamin D) has helped some individuals with TD. Additional study is needed.

Learn more about the workup of TD.


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