Tardive Dyskinesia Video Perspectives

Correll has been a consultant and/or advisor to or has received honoraria from AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Seqirus, SK Life Science, Sunovion, Sun Pharma, Supernus, Takeda, Teva, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Sage, Supernus, Tolmar and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Mindpax, LB Pharma, PsiloSterics and Quantic.

May 25, 2023

2 min watch

Save

VIDEO: Current treatment options for tardive dyskinesia

Transcript

Editor’s note: This is an automatically generated transcript, which has been slightly edited for clarity. Please notify iwaters@healio.com if there are concerns regarding accuracy of the transcription.

In terms of treatment options, we can classify them into prevention and intervention. So, prevention means really only choose a dopamine antagonist when it's needed. Use the conservative lowest, necessary dose, and also the duration that is only necessary. Clearly consider second-generation agents over first-generation agents and inform caregivers about the risk of this treatment.

And clearly you need to also assess for signs of tardive dyskinesia, ideally using the Abnormal Involuntary Movement Scale, the AIMS, because without that you can't treat, because you don't know that patients actually have that.

There are treatment options that have very little evidence. Branched-chain amino acids, amantadine, tetrabenazine, antioxidants like vitamin e, ginkgo biloba, fish oil, Clonazepam has been used. None of these treatments are approved, and now we have actually two treatments that are FDA-approved, and also recommended by the APA guidelines. They are deutetrabenazine and valbenazine.

These are two VMAT-2 inhibitors. What's a VMAT-2 inhibitor? It's a vesicular monoamine transporter-2 inhibitor. These transporters help the packaging of biogenic amines into the presynaptic terminal in through some of these vesicles. So, it's particularly dopamine, but also histamines, serotonin, noradrenaline. And by blocking these in a reversible way, these transporters, there is less dopamine available that can be released, and that will hit upregulated postsynaptic dopamine receptors.