Why INGREZZA?

Not an actual patient
Assess patients for TD

Tardive dyskinesia management starts with accurate assessments

The examples below may be similar to patients in your practice

Review the case study examples of patients and assess whether they may have tardive dyskinesia (TD).

 

Be sure to look for1-5

  • Choreiform (rapid and jerky) movements of the eyes, lips, jaw, tongue, and limbs
  • Athetoid (slow, snake-like, and writhing) movements of the hands, feet, and trunk
  • Delayed onset, with movements generally emerging months to several years after initiating antipsychotics
  • Movements emerging after discontinuation of antipsychotics
  • Movements that may be temporarily masked by a dose increase
  • Portrayals of tardive dyskinesia movements
    Paul L

    53 years old with bipolar disorder

  • Portrayals of tardive dyskinesia movements
    Diana J

    32 years old with schizophrenia

  • Portrayals of tardive dyskinesia movements
    Ashley Q

    56 years old with schizoaffective disorder and anxiety disorder

  • Portrayals of tardive dyskinesia movements
    Stanley H

    48 years old with a history of major depression

Meet Paul L

a 53-year-old married man with a history of bipolar disorder

  • Paul’s bipolar disorder is currently stable since adding olanzapine, a second-generation antipsychotic, to his treatment regimen 11 months ago
  • Paul’s wife, who helps coordinate his care, has noticed him exhibiting persistent, excessive eye blinking
  • She has also recently noticed repetitive hand movements and trunk swaying
  • Others have also mentioned Paul’s movements, which has made him self-conscious and averse to spending time in public

Might Paul have TD?

YES

NO

Paul may have TD.

Although his bipolar disorder is stable after adding a new second-generation antipsychotic to his treatment regimen, he has developed involuntary movements. They appear to be choreiform movements of the eyes and athetoid movements of the hands and trunk.

Next: Assess Diana J

Not an actual patient

Meet Diana J

a 32-year-old single woman with a history of schizophrenia

  • Diana has been hospitalized several times in the last 2 years and has cycled through multiple first-generation and second-generation antipsychotics
  • Diana has a history of acute EPS, for which she was given anticholinergics, which alleviated the rhythmic tremors she noticed in her hands when at rest
  • She has achieved stability on her current treatment regimen but has begun to exhibit jaw distension, lip puckering, and writhing hand movements
  • Diana has struggled to find and maintain employment and is currently living in a group home environment
  • She is usually unaware of her movements unless others point them out

Might Diana have TD?

YES

NO

Diana may have TD.

Over the past 2 years, she has taken multiple DRBAs (ie, first-generation and second-generation antipsychotics). Despite achieving stability in her schizophrenia on her current DRBA, Diana is exhibiting choreiform movements of her jaw and lips, as well as athetoid movements in her hands.

Next: Assess Ashley Q

Not an actual patient

Meet Ashley Q

a 56-year-old married woman with schizoaffective disorder and anxiety disorder

  • Ashley currently works part time as an office receptionist since her condition was stabilized over a year ago, when she was switched from a first-generation antipsychotic to aripiprazole, a second-generation antipsychotic
  • Before her condition stabilized, Ashley was also diagnosed with anxiety disorder, for which she was prescribed a benzodiazepine twice daily (bid)
  • Recently, she began noticing persistent jaw distension, grimacing, and piano fingers
  • Ashley has expressed concern about how her movements may affect her typing and interactions with others at the office

Might Ashley have TD?

YES

NO

Ashley may have TD.

She is exhibiting signs of TD, such as choreiform movements in her jaw and mouth and athetoid movements in her hands. Switching to a new second-generation antipsychotic helped stabilize her schizoaffective disorder, but her TD signs show no improvement.

Next: Assess Stanley H

Not an actual patient

Meet Stanley H

a 48-year-old single man with a history of major depression

  • Stanley adjunctively started quetiapine, a second-generation antipsychotic, 6 months ago; he has recently developed involuntary tongue protrusion and lip smacking
  • As a business manager, Stanley is often involved in new proposals; his colleagues have noticed his movements and are growing concerned that they may impact his work
  • Stanley considered stopping the use of his medications due to his discomfort with involuntary movements

Might Stanley have TD?

YES

NO

Stanley may have TD.

Despite a relatively short period of time on a second-generation antipsychotic, he has developed choreiform movements in his tongue and lips. These movements have worsened and become a concern for his friends and colleagues.

Not an actual patient
  • Not an actual patient

    Meet Paul L

    a 53-year-old married man with a history of bipolar disorder

    Assess Paul
    • Paul’s bipolar disorder is currently stable since adding olanzapine, a second-generation antipsychotic, to his treatment regimen 11 months ago
    • Paul’s wife, who helps coordinate his care, has noticed him exhibiting persistent, excessive eye blinking
    • She has also recently noticed repetitive hand movements and trunk swaying
    • Others have also mentioned Paul’s movements, which has made him self-conscious and averse to spending time in public

    Might Paul have TD?

    YES

    NO

    Paul may have TD.

    Although his bipolar disorder is stable after adding a new second-generation antipsychotic to his treatment regimen, he has developed involuntary movements. They appear to be choreiform movements of the eyes and athetoid movements of the hands and trunk.

    Next: Assess Diana J

  • Not an actual patient

    Meet Diana J

    a 32-year-old single woman with a history of schizophrenia

    Assess Diana
    • Diana has been hospitalized several times in the last 2 years and has cycled through multiple first-generation and second-generation antipsychotics
    • Diana has a history of acute EPS, for which she was given anticholinergics, which alleviated the rhythmic tremors she noticed in her hands when at rest
    • She has achieved stability on her current treatment regimen but has begun to exhibit jaw distension, lip puckering, and writhing hand movements
    • Diana has struggled to find and maintain employment and is currently living in a group home environment
    • She is usually unaware of her movements unless others point them out

    Might Diana have TD?

    YES

    NO

    Diana may have TD.

    Over the past 2 years, she has taken multiple DRBAs (ie, first-generation and antipsychotics). Despite achieving stability in her schizophrenia on her current DRBA, Diana is exhibiting choreiform movements of her jaw and lips, as well as athetoid movements in her hands.

    Next: Assess Ashley Q

  • Not an actual patient

    Meet Ashley Q

    a 56-year-old married woman with schizoaffective disorder and anxiety disorder

    Assess Ashley
    • Ashley currently works part time as an office receptionist since her condition was stabilized over a year ago, when she was switched from a first-generation antipsychotic to aripiprazole, a second-generation antipsychotic
    • Before her condition stabilized, Ashley was also diagnosed with anxiety disorder, for which she was prescribed a benzodiazepine twice daily (bid)
    • Recently, she began noticing persistent jaw distension, grimacing, and piano fingers
    • Ashley has expressed concern about how her movements may affect her typing and interactions with others at the office

    Might Ashley have TD?

    YES

    NO

    Ashley may have TD.

    She is exhibiting signs of TD, such as choreiform movements in her jaw and mouth and athetoid movements in her hands. Switching to a new DRBA (ie, second-generation antipsychotic) helped stabilize her schizoaffective disorder, but her TD signs show no improvement.

    Next: Assess Stanley H

  • Not an actual patient

    Meet Stanley H

    a 48-year-old single man with a history of major depression

    Assess Stanley
    • Stanley adjunctively started quetiapine, a second-generation antipsychotic, 6 months ago; he has recently developed involuntary tongue protrusion and lip smacking
    • As a business manager, Stanley is often involved in new proposals; his colleagues have noticed his movements and are growing concerned that they may impact his work
    • Stanley considered stopping the use of his medications due to his discomfort with involuntary movements

    Might Stanley have TD?

    YES

    NO

    Stanley may have TD.

    Despite a relatively short period of time on a DRBA (ie, second-generation antipsychotic), he has developed choreiform movements in his tongue and lips. These movements have worsened and become a concern for his friends and colleagues.

TD requires unique management

TD is a condition that requires unique management

There is insufficient evidence demonstrating the benefit of stopping or switching antipsychotic agents to treat TD in some patients6,7

  • The 2013 American Academy of Neurology (AAN) Guidelines indicate that there is a lack of clear evidence to support withdrawing causative agents or switching from first-generation to second-generation antipsychotics to treat TD6
  • Changing the antipsychotic regimen may destabilize the underlying psychiatric condition7

Evidence suggests that VMAT2 inhibitors should be considered as first-line therapy based on a systematic review of literature covering 6 years (2012-2017)7

FDA-approved treatment may help reduce TD movements without disrupting the antipsychotic regimen.8,9

2018 practical treatment algorithm for tardive dyskinesia

This algorithm is adapted for the management of troublesome TD symptoms in patients receiving an approved antipsychotic treatment as indicated. Assessment of TD is necessary prior to treatment.7,a

Treatment algorithm for tardive dyskinesia VMAT2 inhibitor valbenazine Treatment algorithm for tardive dyskinesia VMAT2 inhibitor valbenazine
  • aAdapted from 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.
  • GPi DBS, globus pallidus interna deep brain stimulation.
INGREZZA inhibits VMAT2

VMAT2 contributes to hyperactive dopamine signaling and TD8,10,11

Click the numbers below to see how TD works.

  • 1

    TD is associated with prolonged exposure to dopamine receptor blocking agents (DRBAs), including antipsychotics10,12

  • 2

    This is believed to cause hypersensitivity in postsynaptic dopamine D2 receptors in one of the areas of the brain that controls motor function10,12

1 2 VMAT2 transporter protein dopamine receptor INGREZZA™ (valbenazine) VMAT2 dopamine signaling

INGREZZA selectively inhibits VMAT28

Click the numbers below to see how INGREZZA is believed to work.

INGREZZA is a specific VMAT2 inhibitor, with no appreciable off-target binding affinity for serotonergic or dopaminergic receptors8

While the MOA is not fully understood, it is believed that

  • 1

    It may be mediated through selective inhibition of VMAT2 in presynaptic neurons8,10

  • 2

    INGREZZA provides reversible reductions of dopamine release into the synaptic cleft8,10

  • 3

    INGREZZA reduces the amount of dopamine available to hypersensitive postsynaptic dopamine D2 receptors8,10

1 2 3 INGREZZA valbenazine selectively inhibits VMAT2 in tardive dyskinesia INGREZZA™ (valbenazine) VMAT2 inhibiting