Photo (close up) of “Laura,” a TD patient with a mood disorder
Laura

Mood Disorder

Patients with mood disorder are at increased risk of TD. Follow Laura, a patient with bipolar depression who develops TD and overcomes treatment hesitancy, on her treatment journey.
Photo (close up) of “Joe,” a TD patient with schizophrenia
Joe

TD and DIP

It is essential to differentiate TD from drug-induced parkinsonism (DIP), as anticholinergic treatment that is indicated for DIP can worsen TD. Meet Joe, a patient with a history of DIP and anticholinergic use who develops TD.
Photo (close up) of “Chris,” a TD patient with drug-drug interactions
Chris

Drug-Drug Interactions

Review dosing adjustments required for vesicular monoamine transporter 2 (VMAT2) inhibitors in patients with the potential for drug‑drug interactions in Chris’s journey.
Photo (close up) of “Eva,” looking straight into camera, hair pulled back
Eva

Long-term Treatment

TD is a lifelong disease. To learn more about treatment strategies over the long term, see Eva’s story.
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The Ambition

  • Blue-Checkmark Regular screening for movements in patients taking APDs
  • Blue-Checkmark Accurate diagnosis of TD
  • Blue-Checkmark Assessment of impact
  • Blue-Checkmark Appropriate treatment
  • Blue-Checkmark Patient willingness to treat TD
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Potential Barriers

  • Orange-Exclamation Missed diagnosis: lack of routine screening (eg, with the Abnormal Involuntary Movement Scale)
  • Orange-Exclamation Misdiagnosis (eg, extrapyramidal symptoms, DIP)
  • Orange-Exclamation Failure to assess impact
  • Orange-Exclamation Inappropriate treatment (eg, anticholinergics)
  • Orange-Exclamation Patient hesitancy to treat TD
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Treatment Considerations

If the patient is offered treatment with a VMAT2 inhibitor, consider:

  • Purple checkmark Potential drug-drug interactions
  • Purple checkmark Appropriate dosing
  • Purple checkmark Long-term results

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Overview of the Patient Journey

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Summary:

Every patient with TD has a different journey to positive treatment outcomes, and each may be beset with barriers along the way. Some of these barriers may be the result of patient choices while others may be clinician-related.

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Overview References:

American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. Washington, DC:

American Psychiatric Association; 2021.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. Washington, DC: American Psychiatric Association; 2022.

Caroff SN et al. J Clin Psychiatry. 2020;81(2):19cs12983.

Caroff SN. Neuropsychiatr Dis Treat. 2019;15:785-794.

Chepke C et al. Prim Care Companion CNS Discord. 2023;25(4):22m03472.

Fahn S et al. Principles and Practice of Movement Disorders. 2nd ed. Elsevier, Inc; 2011.

Hauser RA et al. CNS Spectr. 2022;27(2):208-217.

Jackson R et al. Neuropsych Dis Treat. 2021;17;1589-1597.

Jain R et al. J Clin Psychiatry. 2023;84(3):22m14694.

Zutshi D et al. Tremor Other Hyperkinet Mov (N Y). 2014;4:266.

INDICATIONS AND USAGE

AUSTEDO XR® (deutetrabenazine) extended-release tablets and AUSTEDO® (deutetrabenazine) tablets are indicated in adults for the treatment of chorea associated with Huntington’s disease and for the treatment of tardive dyskinesia.

IMPORTANT SAFETY INFORMATION

Depression and Suicidality in Patients with Huntington’s Disease: AUSTEDO XR® and AUSTEDO® can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease. Balance the risks of depression and suicidality with the clinical need for treatment of chorea. Closely monitor patients for the emergence or worsening of depression, suicidality, or unusual changes in behavior. Inform patients, their caregivers, and families of the risk of depression and suicidality and instruct them to report behaviors of concern promptly to the treating physician. Exercise caution when treating patients with a history of depression or prior suicide attempts or ideation. AUSTEDO XR and AUSTEDO are contraindicated in patients who are suicidal, and in patients with untreated or inadequately treated depression.

Contraindications: AUSTEDO XR and AUSTEDO are contraindicated in patients with Huntington’s disease who are suicidal, or have untreated or inadequately treated depression. AUSTEDO XR and AUSTEDO are also contraindicated in: patients with hepatic impairment; patients taking reserpine or within 20 days of discontinuing reserpine; patients taking monoamine oxidase inhibitors (MAOIs), or within 14 days of discontinuing MAOI therapy; and patients taking tetrabenazine or valbenazine.

Clinical Worsening and Adverse Events in Patients with Huntington’s Disease: AUSTEDO XR and AUSTEDO may cause a worsening in mood, cognition, rigidity, and functional capacity. Prescribers should periodically re-evaluate the need for AUSTEDO XR or AUSTEDO in their patients by assessing the effect on chorea and possible adverse effects.

QTc Prolongation: AUSTEDO XR and AUSTEDO may prolong the QT interval, but the degree of QT prolongation is not clinically significant when AUSTEDO XR or AUSTEDO is administered within the recommended dosage range. AUSTEDO XR and AUSTEDO should be avoided in patients with congenital long QT syndrome and in patients with a history of cardiac arrhythmias.

Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex reported in association with drugs that reduce dopaminergic transmission, has been observed in patients receiving tetrabenazine. The risk may be increased by concomitant use of dopamine antagonists or antipsychotics. The management of NMS should include immediate discontinuation of AUSTEDO XR and AUSTEDO; intensive symptomatic treatment and medical monitoring; and treatment of any concomitant serious medical problems.

Akathisia, Agitation, and Restlessness: AUSTEDO XR and AUSTEDO may increase the risk of akathisia, agitation, and restlessness. The risk of akathisia may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops akathisia, the AUSTEDO XR or AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.

Parkinsonism: AUSTEDO XR and AUSTEDO may cause parkinsonism in patients with Huntington’s disease or tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. The risk of parkinsonism may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops parkinsonism, the AUSTEDO XR or AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.

Sedation and Somnolence: Sedation is a common dose-limiting adverse reaction of AUSTEDO XR and AUSTEDO. Patients should not perform activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, until they are on a maintenance dose of AUSTEDO XR or AUSTEDO and know how the drug affects them. Concomitant use of alcohol or other sedating drugs may have additive effects and worsen sedation and somnolence.

Hyperprolactinemia: Tetrabenazine elevates serum prolactin concentrations in humans. If there is a clinical suspicion of symptomatic hyperprolactinemia, appropriate laboratory testing should be done and consideration should be given to discontinuation of AUSTEDO XR and AUSTEDO.

Binding to Melanin-Containing Tissues: Deutetrabenazine or its metabolites bind to melanin-containing tissues and could accumulate in these tissues over time. Prescribers should be aware of the possibility of long-term ophthalmologic effects.

Common Adverse Reactions: The most common adverse reactions for AUSTEDO (>8% and greater than placebo) in a controlled clinical study in patients with Huntington’s disease were somnolence, diarrhea, dry mouth, and fatigue. The most common adverse reactions for AUSTEDO (4% and greater than placebo) in controlled clinical studies in patients with tardive dyskinesia were nasopharyngitis and insomnia. Adverse reactions with AUSTEDO XR extended-release tablets are expected to be similar to AUSTEDO tablets.

Please see accompanying full Prescribing Information, including Boxed Warning.