Deutetrabenazine: deuterium-modified tetrabenazine; twice-daily dosing; more stable plasma levels than tetrabenazine; CYP2D6 metabolism
Both FDA-approved; network meta-analysis (Solmi 2025) supports both as most effective pharmacological options
Head-to-head trials limited; choice based on dosing preference, comorbidities, drug interactions
Evidence base
AAN 2013 guideline: clonazepam (Level B), ginkgo biloba (Level B), amantadine (Level C), tetrabenazine (Level C)
FDA approval of valbenazine 2017 and deutetrabenazine 2017 based on Phase 3 randomized controlled trials
Canadian Journal of Psychiatry 2019 treatment recommendations support VMAT2 inhibitors as first-line
Bhidayasiri et al. 2018 updated algorithm recommends reducing/stopping DRBA first, then VMAT2 inhibitors
Patient Discharge Instructions
copy discharge instructions
What is tardive dyskinesia?
TD is a movement disorder caused by medications that block dopamine receptors in the brain
Common causative medications include antipsychotics (for mental health conditions) and some anti-nausea medications such as metoclopramide
Symptoms include uncontrolled movements of the face, tongue, lips, hands, or body
TD can be a permanent condition but treatment can reduce symptoms significantly
Your medications
Do not stop or change your psychiatric medications without speaking to your psychiatrist first — abrupt stopping can cause serious psychiatric relapse
Avoid all anticholinergic medications — these can worsen your involuntary movements
Common anticholinergics to avoid: benztropine (Cogentin), diphenhydramine (Benadryl), trihexyphenidyl
If started on valbenazine (Ingrezza): take once daily; can be taken with or without food
If started on deutetrabenazine (Austedo): take twice daily with food — food is required for proper absorption
Both medications work slowly — improvement may take several weeks
Follow-up instructions
Follow up with your psychiatrist within 1-2 weeks for medication review and treatment adjustment
Neurologist or movement disorder specialist referral may be arranged for further evaluation
Bring a list of all your current medications to every appointment
Serial movement assessments (AIMS scale) will be performed at follow-up visits to track your progress
Diet and daily life
If you have difficulty chewing or swallowing, eat soft foods and take small bites
Avoid stimulants including caffeine and recreational drugs — these can worsen movements
Report any difficulty breathing, swallowing, or eating to your doctor immediately
Return to emergency department immediately for
Difficulty breathing or irregular breathing pattern
Inability to eat, drink, or swallow safely
High fever, severe muscle stiffness, or confusion — these may indicate a serious drug reaction
Worsening involuntary movements
New or worsening thoughts of self-harm or suicide
Falls or injuries related to involuntary movements
References
Guidelines and key sources
American Psychiatric Association DSM-5-TR (2022)
Diagnostic criteria for tardive dyskinesia
Duration criteria: >= 3 months DRBA exposure (>= 1 month if age >= 60)
AAN Evidence-Based Guideline: Treatment of Tardive Syndromes (Bhidayasiri et al., Neurology 2013)
Clonazepam: Level B (probably effective)
Ginkgo biloba 240 mg/day: Level B (probably effective)
Amantadine and tetrabenazine: Level C (possibly effective)
Bhidayasiri et al. Journal of Neurological Sciences 2018
Updated treatment algorithm; systematic review of new evidence
VMAT2 inhibitors added as preferred first-line treatment
FDA Drug Label: Valbenazine (Ingrezza) — Updated 2026
40 mg daily for 1 week, then 80 mg daily
Dose adjustment for hepatic impairment and CYP2D6 poor metabolizers
Ricciardi L et al. Canadian Journal of Psychiatry 2019
Treatment recommendations for tardive dyskinesia
VMAT2 inhibitors as first-line pharmacotherapy
Factor SA et al. Lancet Neurology 2019
Recent developments in drug-induced movement disorders
Distinguishing features of TD, acute dystonia, akathisia, drug-induced parkinsonism
Key clinical evidence
Marder SR, Cannon TD. NEJM 2019
Annualized TD incidence: 5.5% per year first-generation antipsychotics; 3.9% second-generation
TD prevalence: 32% first-generation vs 13% second-generation antipsychotics
Correll CU, Citrome L. Journal of Clinical Psychiatry 2021
Diagnostic and treatment fundamentals for tardive dyskinesia
Serial AIMS assessment recommended at baseline and each follow-up visit
Solmi M et al. Molecular Psychiatry 2025
Network meta-analysis of pharmacological interventions for TD
Valbenazine and deutetrabenazine most effective options by evidence synthesis
Citrome L. Expert Review of Neurotherapeutics 2018
VMAT2 inhibitors in clinical perspective
Drug interaction profiles for valbenazine and deutetrabenazine
Khorassani F et al. AJHP 2020
Comparative pharmacology of valbenazine and deutetrabenazine
Dosing, drug interactions, and special population considerations
American Geriatrics Society Beers Criteria 2023 (Steinman MA, JAGS 2025)
Anticholinergics listed on Beers Criteria — worsen TD and cause cognitive impairment in elderly
Guidance for avoiding anticholinergic medications in geriatric patients
Stahl SM et al. Acta Psychiatrica Scandinavica 2021
Management of antipsychotic adverse effects
Treatment approach for drug-induced movement disorders in clinical practice
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.