Tardive dyskinesia treatment guidelines
and recommendations

Treat first line with VMAT2 inhibitors

Experts agree that VMAT2 inhibitors are the preferred first-line treatment for tardive dyskinesia (TD)1-3

2020 American Psychiatric Association guidelines1

  • Treatment with a VMAT2 inhibitor is recommended in patients with moderate to severe TD and may also be considered in patients with mild TD

Systematic review of new evidence since 2013 American Academy of Neurology guidelines2

  • New generation VMAT2 inhibitors should be recommended as first-line treatment for TD

2020 Delphi Panel consensus recommendations3

  • Treatment of TD with a VMAT2 inhibitor should be considered as part of a comprehensive treatment plan

INGREZZA® (VALBENAZINE) CAPSULES IS RECOMMENDED AS A FIRST-LINE TREATMENT OPTION FOR ADULTS WITH TARDIVE DYSKINESIA (TD)1-3

Preserve antipsychotic regimens

INGREZZA offers the ability to treat TD while preserving your patient’s antipsychotic regimen4

2013 American Academy of Neurology guidelines5

  • There is a lack of clear evidence to support or refute withdrawing or switching antipsychotics to treat TD
  • Changing a patient’s antipsychotic regimen may destabilize the underlying psychiatric condition

2020 American Psychiatric Association guidelines1

  • TD may persist, and may even worsen, despite reduction in dose or discontinuation of antipsychotics

Is it time to think differently about tardive dyskinesia (TD) treatment?

TD is distinct from other drug-induced movement disorders and requires unique treatment.6 Anticholinergics do not reduce and could even increase the risk for TD, despite widespread use for prophylaxis and treatment of acute drug-induced movement disorders, like parkinsonism.7,8

2020 American Psychiatric Association guidelines1

  • Anticholinergic medications do not improve and may even worsen TD

2020 Delphi Panel consensus recommendations3

  • As part of TD management, providers should consider modifying anticholinergic agents (eg, reduce dose, taper off)

2013 American Academy of Neurology guidelines5

  • There are insufficient data to recommend anticholinergics for the treatment of TD

DIFFERENTIATE TD MOVEMENTS

Differentiate the signs of tardive dyskinesia from acute extrapyramidal symptoms (EPS)—learn more

DIFFERENTIATE TD

THE ONLY ONCE-DAILY VMAT2 INHIBITOR

One-capsule, once-daily dosing with three effective dosing options sets INGREZZA apart from other VMAT2 inhibitors4

EXPLORE DOSING

EXPLORE CLINICAL TRIAL VIDEOS

Register for INGREZZA Insider to see real patient case reviews from the KINECT 3 and KINECT 4 clinical trials

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Watch expert perspective videos on screening and managing TD

Featuring Bryce Reynolds, MD

Changing mindsets for tardive dyskinesia (TD) assessments

Watch Motivational Interviewing in TD Video

Using motivational interviewing to talk about tardive dyskinesia (TD) and treatment

Watch Changing Mindsets in TD Video

These videos were sponsored and developed by Neurocrine Biosciences.
The speaker is a paid consultant of Neurocrine Biosciences.

REFERENCES:

  1. Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. American Psychiatric Association Publishing, 2020
  2. 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 Neurol Sci. 2018;389:67-75
  3. Caroff SN, Citrome L, Meyer J, et al. A modified Delphi consensus study of the screening, diagnosis, and treatment of tardive dyskinesia. J Clin Psychiatry. 2020;81(2):19cs12983
  4. INGREZZA [package insert]. San Diego, CA: Neurocrine Biosciences, Inc
  5. 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
  6. Ward KM, Citrome L. Antipsychotic-related movement disorders: drug-induced parkinsonism vs. tardive dyskinesia-key differences in pathophysiology and clinical management. Neurol Ther. 2018;7(2):233-248
  7. 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
  8. Desmarais JE, Beauclair L, Margolese HC. Anticholinergics in the era of atypical antipsychotics: short-term or long-term treatment? J Psychopharmacol. 2012;26(9):1167-1174

Important Information

INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated for the treatment of adults with tardive dyskinesia.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

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

Somnolence

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.

QT Prolongation

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.

Parkinsonism

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.

ADVERSE REACTIONS

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

Indication and Important Safety Information

INGREZZA is contraindicated in patients with a history of hypersensitivity to valbenazine or any components of INGREZZA.

+Expand-Collapse

Rash, urticaria, and reactions consistent with angioedema (e.g., swelling of the face, lips, and mouth) have been reported.

INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated for the treatment of adults with tardive dyskinesia.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

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.

Important Information

INDICATION & USAGE

INGREZZA® (valbenazine) capsules is indicated for the treatment of adults with tardive dyskinesia.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

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

Somnolence

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.

QT Prolongation

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.

Parkinsonism

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.

ADVERSE REACTIONS

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

EXPAND FOR
GUIDELINES

INGREZZA is a recommended first-line TD treatment option.

See guidelines and recommendations