Deutetrabenazine
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Trade Name
Austedo (immediate-release), Austedo XR (extended-release); generic deutetrabenazine
Classification
Vesicular Monoamine Transporter 2 (VMAT2) inhibitor; movement disorder treatment
Dosage/Route
- * Dosage:
- – Immediate-release tablets: 6 mg, 9 mg, 12 mg.
- – Extended-release tablets (XR): 6 mg, 12 mg, 24 mg, 30 mg, 36 mg, 42 mg, 48 mg.
- * Route: Oral (PO)
Usual Dosage
- * Chorea (Huntington’s): Start 6 mg PO once daily (IR) or 6 mg XR daily; increase by 6 mg/week; max 48 mg/day (divided BID for IR if ≥12 mg/day)
- * Tardive Dyskinesia: Start 12 mg PO daily (IR) or 24 mg XR daily; increase by 6-12 mg/week; max 48 mg/day (BID for IR)
- * CYP2D6 poor metabolizers or with inhibitors: Max 36 mg/day (18 mg/dose)
Mechanism of Action
Inhibits VMAT2, reducing uptake of monoamines (dopamine, serotonin, norepinephrine) into synaptic vesicles, depleting their release. This decreases involuntary movements (chorea, dyskinesia) by modulating dopamine activity in the brain
Side Effects & Adverse Effects
- * Side Effects: Somnolence, fatigue, diarrhea, dry mouth, insomnia
- * Adverse Effects:
- – Depression/suicidality (boxed warning, esp. Huntington’s patients)
- – Neuroleptic malignant syndrome (NMS) (rare; fever, rigidity)
- – Parkinsonism or akathisia (restlessness, stiffness)
- – QT prolongation (dose-dependent)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor mood/behavior (suicide risk, esp. in Huntington’s)
- – Assess for NMS (vital signs, rigidity), akathisia, or parkinsonism
- – Check QT interval if dose >24 mg/day in at-risk patients (e.g., hypokalemia)
- – Avoid with MAOIs (within 14 days) or reserpine (within 20 days)
- * Teachings:
- – Take with food (IR); XR with/without food
- – Report mood changes, fever, or restlessness
- – Avoid alcohol/CNS depressants (increases sedation)
- – Don’t drive if drowsy; taper off if stopping (if >1 week interruption, re-titrate)
Indication for This Patient
- * Chorea associated with Huntington’s disease (uncontrolled movements)
- * Tardive dyskinesia (repetitive, involuntary movements from antipsychotics)
Time
- * Timing: IR: Once or twice daily (≥12 mg/day split BID); XR: once daily
- * Onset: Days to weeks for symptom improvement
- * Peak: Steady-state in ~1 week; effect builds over weeks
