Drug Detail:Deutetrabenazine (Deutetrabenazine [ doo-tet-ra-ben-a-zeen ])
Drug Class: VMAT2 inhibitors
Usual Adult Dose for Huntington Disease
- Initial Dose: 6 mg orally once a day
- Maintenance Dose: May increase dose in increments of 6 mg/day at weekly intervals.
- Maximum Dose: 48 mg/day in divided doses
Comments:
- Determine the dose for each patient based on chorea reduction and tolerability.
- Administer total daily dosages of 12 mg or more in 2 divided doses.
- May discontinue this drug without tapering.
- Re-titrate dose when resuming this drug following therapy interruption of greater than 1 week; resume therapy at the previous maintenance dose without titration if treatment interruption is less than 1 week.
- For patients at risk for QT prolongation, assess the QT interval before and after increasing total dosage above 24 mg per day.
Use: For chorea associated with Huntington's disease
Usual Adult Dose for Tardive Dyskinesia
- Initial Dose: 6 mg orally 2 times a day
- Maintenance Dose: May increase dose in increments of 6 mg/day at weekly intervals.
- Maximum Dose: 48 mg/day in divided doses
Comments:
- Determine the dose for each patient based on tardive dyskinesia reduction and tolerability.
- Administer total daily dosages of 12 mg or more in 2 divided doses.
- May discontinue this drug without tapering.
- Re-titrate dose when resuming this drug following therapy interruption of greater than 1 week; resume therapy at the previous maintenance dose without titration if treatment interruption is less than 1 week.
- For patients at risk for QT prolongation, assess the QT interval before and after increasing total dosage above 24 mg per day.
Use: For tardive dyskinesia
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Contraindicated
Dose Adjustments
Patients switching from tetrabenazine to deutetrabenazine: Discontinue tetrabenazine and initiate deutetrabenazine the following day; the initial dose for deutetrabenazine is based on the current tetrabenazine daily dose (TDD):
- If TDD 12.5 mg: Switch to deutetrabenazine 6 mg once a day.
- If TDD 25 mg: Switch to deutetrabenazine 6 mg twice a day.
- If TDD 37.5 mg: Switch to deutetrabenazine 9 mg twice a day.
- If TDD 50 mg: Switch to deutetrabenazine 12 mg twice a day.
- If TDD 62.5 mg: Switch to deutetrabenazine 15 mg twice a day.
- If TDD 75 mg: Switch to deutetrabenazine 18 mg twice a day.
- If TDD 87.5 mg: Switch to deutetrabenazine 21 mg twice a day.
- If TDD 100 mg: Switch to deutetrabenazine 24 mg twice a day.
CYP450 2D6 Poor Metabolizers OR Concomitant Use of Strong CYP450 2D6 Inhibitors:
- Maximum Single Dose: 18 mg
- Maximum Daily Dose: 36 mg
Precautions
US BOXED WARNINGS:
DEPRESSION/SUICIDALITY: This drug can increase the risk of depression and suicidality (suicidal thoughts and behavior) in patients with Huntington's disease; therefore, it is contraindicated in patients with untreated or inadequately treated depression and in those who are suicidal.
- Balance the risks of depression and suicidality with the clinical need for chorea treatment when considering the use of this drug.
- Inform patients, their caregivers, and their families of the risk of depression and suicidality; instruct them to report behaviors of concern to the healthcare provider.
- Monitor patients for the emergence or worsening of depression, suicidality, or unusual behavior changes.
- Exercise caution in treating patients with a history of depression or prior suicide attempts or ideation, which are increased in frequency in Huntington's disease.
CONTRAINDICATIONS:
- In patients with Huntington's disease who are suicidal, or have untreated or inadequately treated depression
- In patients with hepatic impairment
- In patients taking reserpine (at least 20 days should elapse after stopping reserpine before starting this drug
- In MAOI, or within 14 days of discontinuing therapy with an MAOI
- In patients taking tetrabenazine or valbenazine
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration Advice:
- Administer with food.
- Swallow tablets whole; do not chew, crush, or break.
Storage Requirements:
- Store at 25C (77F); excursions permitted to 15C to 30C (59F to 86F).
- Protect from light and moisture.
Monitoring:
- Nervous System: Worsening akathisia, restlessness, or agitation.
- Psychiatric: Worsening depression, suicidality, or unusual behavior changes.
Patient Advice:
- While taking this drug, avoid alcohol and potentially dangerous activities such as driving a car or operating machinery until you know how this drug affects you.
Frequently asked questions
- What's the difference between deutetrabenazine and tetrabenazine?
- Austedo vs Ingrezza: How do they compare?
- What condition is Austedo used to treat?
