Management of new-onset tardive dyskinesia (TD)

The most common manifestations of TD involve spontaneous movements of the mouth and tongue; the arms, legs, trunk, and respiratory muscles can also be affected. Less commonly, the prominent feature is dystonia involving a focal area of the body such as the neck. TD can be irreversible and lifelong, with major negative impacts on psychologic health and quality of life. TD is important to recognize, since early discontinuation of the offending drug offers the best chance of recovery. In patients who require ongoing antipsychotic drug therapy for management of psychiatric disorders, symptomatic therapies for TD can help lessen movements.

VMAT2: vesicular monoamine transporter type 2.
* The most common causes of TD are first-generation antipsychotics, second-generation antipsychotics, metoclopramide, and prochlorperazine.
¶ Among second-generation antipsychotics, clozapine and quetiapine have the lowest risk of perpetuating/worsening TD.
Δ Symptomatic therapies include VMAT2 inhibitors, benzodiazepines, botulinum toxin (for focal dystonia), and anticholinergic therapy (for focal dystonia).
◊ VMAT2 inhibitors for TD include valbenazine, deutetrabenazine, and tetrabenazine. The three drugs have not been compared directly, and regional availability and cost may vary. Valbenazine and deutetrabenazine are generally preferred over tetrabenazine based primarily on longer half-life and convenience.

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Management of new-onset tardive dyskinesia (TD)