Formulary
Tetrabenazine: Indications, Dosing, Side Effects and Interactions
Tetrabenazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Tetrabenazine: Indications, Dosing, Side Effects and Interactions
Tetrabenazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Movement disorders due to Huntington's chorea, hemiballismus, senile chorea, and related neurological conditions**
- **Adult** (By Mouth): Initially 25 mg 3 times a day, then increased, if tolerated, in steps of 25 mg every 3-4 days; maximum 200 mg per day.
- **Elderly** (By Mouth): Lower initial dose may be necessary.
**Moderate to severe tardive dyskinesia**
- **Adult** (By Mouth): Initially 12.5 mg daily, dose to be gradually increased according to response.
Cautions
Susceptibility to QT-interval prolongation
Contraindications
Depression; parkinsonism; phaeochromocytoma; prolactin-dependent tumours
Side effects
Common or very common Anxiety; confusion; constipation; depression; diarrhoea; drowsiness; hypotension; insomnia; nausea; parkinsonism; vomiting Uncommon Consciousness impaired; hyperthermia Rare or very rare Neuroleptic malignant syndrome (discontinue-potentially fatal); skeletal muscle damage Frequency not known Bradycardia; dizziness; dry mouth; epigastric pain; suicidal behaviours
Interactions
**Severe interactions:**
- Other cytochrome P450 inhibitors: On the basis of in vitro studies, clinically significant interactions between tetrabenazine and other P450 inhibitors (other than CYP2D6 inhibitors) are unlikely.
- Should tetrabenazine be administered together with neuroleptics (e.g.
- The physician should wait for the reemergence of chorea symptoms before starting treatment with tetrabenazine, in order to avoid overdose and severe serotonin and noradrenaline depletion in the CNS.
**Other interactions (15):**
- Not all of the metabolising enzymes for tetrabenazine are known.
- In vivo studies indicate that tetrabenazine may be an inhibitor of CYP2D6 and may therefore cause elevated plasma concentrations of edicinal substances that are metabolised via CYP2D6 (e.g.
- In patients already stabilised on tetrabenazine, adjuvant administration of CYP2D6 inhibitors (such as fluoxetine, paroxetine, quinidine, duloxetine, terbinafine, amiodarone or sertraline) should...
- The effect of moderate to weak CYP2D6 inhibitors, e.g.
- Levodopa Tetrabenazine inhibits the action of levodopa and thereby attenuates its efficacy.
- At least 14 days should elapse between discontinuation of tetrabenazine and initiation of treatment with a MAO inhibitor, as well as between discontinuation of a MAO inhibitor and initiation of...
Pregnancy
Avoid unless essential-toxicity in animal studies.
Breast feeding
Avoid.
Hepatic impairment
Manufacturer advises caution (increased risk of exposure), particularly in severe impairment (no information available). Dose adjustments Manufacturer advises initial dose reduction of 50% and slower dose titration in mild to moderate impairment.
Renal impairment
Use with caution (no information available). M
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Tetrabenazine in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

