What is Tetrabenazine: Uses, Dosage, Side Effects and More

Tetrabenazine is a prescription medication that helps control unwanted, excessive movements in people with certain neurological conditions. It works by reducing the amount of dopamine, a brain chemical that affects movement, in specific areas of your brain.

If you or someone you care about has been prescribed this medication, you might have questions about how it works and what to expect. This guide will walk you through everything you need to know about tetrabenazine in clear, straightforward terms.

What is Tetrabenazine?

Tetrabenazine belongs to a class of medications called vesicular monoamine transporter 2 (VMAT2) inhibitors. Think of it as a medication that helps "calm down" overactive movement signals in your brain.

The drug was specifically developed to treat movement disorders where people experience involuntary movements they can't control. It's considered a specialized medication that requires careful monitoring by healthcare providers who understand neurological conditions.

Unlike some medications that work throughout your entire body, tetrabenazine targets very specific pathways in your brain that control movement. This focused approach helps reduce unwanted movements while minimizing effects on other body systems.

What is Tetrabenazine Used For?

Tetrabenazine is primarily prescribed to treat chorea associated with Huntington's disease. Chorea refers to involuntary, jerky movements that can affect your arms, legs, face, and other parts of your body.

Huntington's disease is a genetic condition that gradually affects movement, thinking, and emotions. The chorea movements can be distressing and interfere with daily activities like eating, walking, or speaking clearly.

Your doctor might also consider tetrabenazine for other movement disorders, though this would be what's called "off-label" use. These conditions might include:

• Tardive dyskinesia (involuntary movements caused by certain psychiatric medications)
• Tics in Tourette syndrome that haven't responded to other treatments
• Other types of chorea not related to Huntington's disease
• Certain cases of dystonia (muscle contractions causing abnormal postures)

Each person's situation is unique, and your doctor will carefully evaluate whether tetrabenazine is right for your specific condition and symptoms.

How Does Tetrabenazine Work?

Tetrabenazine works by blocking the storage and release of dopamine in specific brain areas that control movement. It's considered a moderately strong medication that requires gradual dose adjustments.

To understand how it works, imagine dopamine as a messenger that carries movement signals in your brain. In conditions like Huntington's disease, these signals become overactive, leading to unwanted movements.

The medication essentially "turns down the volume" on these overactive dopamine signals. It does this by preventing dopamine from being properly stored and released at nerve endings, which helps reduce the excessive movement signals.

The effects of tetrabenazine are reversible, meaning if you stop taking the medication, your dopamine levels will gradually return to their previous state. This is different from some other medications that cause permanent changes.

How Should I Take Tetrabenazine?

Take tetrabenazine exactly as your doctor prescribes, usually with food to help reduce stomach upset. The medication comes in tablet form and should be swallowed whole with water.

Your doctor will start you on a low dose and gradually increase it over several weeks. This slow approach helps your body adjust to the medication and reduces the risk of side effects.

Here's what you should know about taking tetrabenazine properly:

• Take it at the same times each day to maintain steady levels in your body
• Don't crush, chew, or break the tablets
• Take it with food or milk to minimize stomach irritation
• If you take it multiple times per day, space the doses evenly
• Don't stop taking it suddenly without talking to your doctor first

Your doctor will monitor you closely, especially during the first few months of treatment. They may adjust your dose based on how well the medication is working and any side effects you experience.

How Long Should I Take Tetrabenazine For?

The length of treatment with tetrabenazine depends on your specific condition and how well you respond to the medication. For Huntington's disease, treatment is typically long-term since it's a progressive condition.

Your doctor will regularly evaluate whether the medication is still helping you and if the benefits continue to outweigh any side effects. Some people may need to take it for many years, while others might use it for shorter periods.

The decision to continue or stop treatment should always be made with your healthcare provider. They'll consider factors like how much the medication is helping your symptoms, any side effects you're experiencing, and changes in your overall condition.

If you ever need to stop taking tetrabenazine, your doctor will typically reduce your dose gradually rather than stopping it all at once. This helps prevent any potential withdrawal effects or sudden worsening of symptoms.

What Are the Side Effects of Tetrabenazine?

Like all medications, tetrabenazine can cause side effects, though not everyone experiences them. The most common side effects are usually mild to moderate and often improve as your body adjusts to the medication.

Understanding what to expect can help you feel more prepared and know when to contact your healthcare provider. Let's look at the different types of side effects you might experience.

Common Side Effects

These side effects occur in many people taking tetrabenazine and are generally manageable:

• Drowsiness or fatigue (feeling more tired than usual)
• Depression or mood changes
• Restlessness or anxiety
• Difficulty sleeping (insomnia)
• Nausea or stomach upset
• Dizziness, especially when standing up
• Difficulty concentrating

Most of these effects are more noticeable when you first start taking the medication or when your dose is increased. They often become less bothersome as your body adapts to the treatment.

Serious Side Effects

While less common, some side effects require immediate medical attention. Contact your doctor right away if you experience:

• Severe depression or thoughts of suicide
• Difficulty swallowing or breathing
• High fever with muscle stiffness
• Irregular heartbeat or chest pain
• Severe restlessness or agitation
• Uncontrollable muscle movements in your face or body

These serious side effects are rare, but it's important to be aware of them and seek medical help immediately if they occur.

Rare Side Effects

Some people may experience less common side effects that still warrant attention:

• Neuroleptic malignant syndrome (a rare but serious condition with high fever, muscle rigidity, and confusion)
• Prolonged QT interval (a heart rhythm change that shows up on an EKG)
• Severe drops in blood pressure
• Parkinsonism (tremor, stiffness, and slow movement)
• Akathisia (severe restlessness and need to move constantly)

Your doctor will monitor you for these rare but serious effects, especially during the early stages of treatment.

Who Should Not Take Tetrabenazine?

Tetrabenazine isn't suitable for everyone, and certain conditions or circumstances make it unsafe to use. Your doctor will carefully review your medical history before prescribing this medication.

You should not take tetrabenazine if you have severe depression or are having thoughts of suicide. The medication can worsen depression, so it's crucial to address any mental health concerns before starting treatment.

Other important contraindications include:

• Untreated or inadequately treated depression
• Active suicidal thoughts or recent suicide attempts
• Taking monoamine oxidase inhibitors (MAOIs) or have taken them within the past 14 days
• Severe liver problems
• Known allergy to tetrabenazine or its components

Certain conditions require extra caution and close monitoring if you take tetrabenazine:

• History of depression or other mental health conditions
• Heart problems or irregular heart rhythms
• Liver disease
• Kidney problems
• Parkinson's disease
• Swallowing difficulties

Always tell your doctor about all your medical conditions, including any history of mental health issues, even if they seem unrelated to your movement disorder.

Tetrabenazine Brand Names

Tetrabenazine is available under the brand name Xenazine in the United States. This is the most commonly prescribed form of the medication.

There's also a newer, related medication called deutetrabenazine, which is sold under the brand name Austedo. This is a modified version of tetrabenazine that may have some advantages in terms of dosing frequency and side effects.

Your doctor will determine which form of the medication is most appropriate for your specific situation. Both medications work similarly, but there may be differences in how often you need to take them and their side effect profiles.

Always use the exact brand and formulation your doctor prescribes, as switching between different versions should only be done under medical supervision.

Tetrabenazine Alternatives

If tetrabenazine isn't suitable for you or doesn't work well, your doctor might consider other treatment options. The choice of alternative depends on your specific condition and symptoms.

For Huntington's disease chorea, alternatives might include:

• Deutetrabenazine (Austedo) - a newer, similar medication
• Antipsychotic medications like haloperidol or olanzapine
• Benzodiazepines for anxiety and some movement symptoms
• Anti-seizure medications like valproic acid

For other movement disorders, your doctor might consider:

• Botulinum toxin injections for localized muscle problems
• Deep brain stimulation for certain conditions
• Other dopamine-blocking medications
• Physical therapy and occupational therapy

The best treatment approach often involves combining medication with other therapies like physical therapy, speech therapy, or counseling to address the various aspects of movement disorders.

Is Tetrabenazine Better Than Deutetrabenazine?

Both tetrabenazine and deutetrabenazine are effective medications for treating movement disorders, but they have some important differences that might make one more suitable for you than the other.

Deutetrabenazine (Austedo) is a newer medication that was developed to improve upon tetrabenazine. The main advantages of deutetrabenazine include:

• Less frequent dosing (usually twice daily instead of three times daily)
• More predictable levels in your body
• Potentially fewer side effects
• Less interaction with certain genetic factors that affect drug metabolism

However, tetrabenazine has been used longer and has more extensive research behind it. Some people may respond better to one medication than the other, and cost considerations might also play a role in the decision.

Your doctor will consider factors like your specific symptoms, other medications you take, your daily schedule, and insurance coverage when deciding which medication is best for you. Neither medication is universally "better" - the choice depends on your individual circumstances.