Impact of tardive dyskinesia
Not an actual patient
Tardive dyskinesia (TD) is a clinically distinct, drug-induced movement disorder1,2
TD is associated with prolonged exposure to dopamine receptor blocking agents (DRBAs), including first- and second-generation antipsychotics1
TD may affect more than one area of the body—not just the face1-3
Select a body area to see examples.
How is TD different from other drug-induced movement disorders?
Dr. Laxman Bahroo, from Georgetown University’s Neurology Department, shows the clinical distinctions between TD and other drug-induced movement disorders.
Excessive blinking, squinting
Previous: Lower Limbs
Tardive dyskinesia may be disruptive2,4
TD is a potentially irreversible drug-induced movement disorder that is often persistent1,5
Medications associated with TD include6–8
First-generation (typical) antipsychotics
Second-generation (atypical) antipsychotics
Medications for gastrointestinal motility or nausea/vomiting
There is insufficient evidence demonstrating the benefit of stopping or switching antipsychotic agents for treating TD in some patients.9
TD may negatively impact patients11
TD may result in2,4
Exacerbation of stigma associated with existing mental illness
INDICATION & USAGE
INGREZZA® (valbenazine) capsules is indicated for the treatment of adults with tardive dyskinesia.
IMPORTANT SAFETY INFORMATION
INGREZZA is contraindicated in patients with a history of hypersensitivity to valbenazine or any components of INGREZZA. Rash, urticaria, and reactions consistent with angioedema (e.g., swelling of the face, lips, and mouth) have been reported.
WARNINGS & PRECAUTIONS
INGREZZA can cause somnolence. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA.
INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage.
INGREZZA may cause parkinsonism in patients with tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. Reduce the dose or discontinue INGREZZA treatment in patients who develop clinically significant parkinson-like signs or symptoms.
The most common adverse reaction (≥5% and twice the rate of placebo) is somnolence. Other adverse reactions (≥2% and >Placebo) include: anticholinergic effects, balance disorders/falls, headache, akathisia, vomiting, nausea, and arthralgia. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see INGREZZA full Prescribing Information
REFERENCES: 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 2. Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992. 3. Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976. 4. Boumans CE, de Mooij KJ, Koch PA, et al. Is the social acceptability of psychiatric patients decreased by orofacial dyskinesia? Schizophr Bull. 1994;20(2):339-344. 5. Factor SA, Remington G, Comella CL, et al. The effects of valbenazine in participants with tardive dyskinesia: results of the 1-year KINECT 3 extension study. J Clin Psychiatry. 2017;78(9):1344-1350. 6. Hauser RA, Factor SA, Marder SR, et al. KINECT 3: a phase 3 randomized, double-blind, placebo-controlled trial of valbenazine for tardive dyskinesia. Am J Psychiatry. 2017;174(5):476-484. 7. Mental health medications. National Institute of Mental Health website. https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml. Updated October 2016. Accessed August 23, 2018. 8. Metoclopramide. PubChem website. https://pubchem.ncbi.nlm.nih.gov/compound/metoclopramide. Accessed August 23, 2018. 9. Summary of evidence-based guidelines for clinicians: treatment of tardive syndromes. American Academy of Neurology website. https://www.aan.com/Guidelines/Home/GetGuidelineContent/613. Published 2013. Accessed August 22, 2018. 10. Bhidayasiri R, Jitkritsadakul O, Friedman JH, Fahn S. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. J Neuro Sci. 2018;389:67-75. 11. Ascher-Svanum H, Zhu B, Faries D, et al. Tardive dyskinesia and the 3-year course of schizophrenia: results from a large, prospective, naturalistic study. J Clin Psychiatry. 2008;69(10):1580-1588. 12. Carbon M, Hsieh C-H, Kane JM, Correll CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264-e278. 13. Data on file. Neurocrine Biosciences, Inc. 14. Woerner MG, Alvir JM, Saltz BL, Lieberman JA, Kane JM. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998;155(11):1521-1528. 15. Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005;80(1):33-43. 16. Turrone P, Seeman MV, Silvestri S. Estrogen receptor activation and tardive dyskinesia. Can J Psychiatry. 2000;45(3):288-290. 17. Casey DE. Affective disorders and tardive dyskinesia. Encephale. 1988;14(spec):221-226. 18. Divac N, Prostran M, Jakovcevski I, Cerovac N. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int. 2014;2014:656370.
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