Valbenazine
INGREZZA
What it isReversible VMAT2 inhibitor that reduces presynaptic dopamine packaging; tardive dyskinesia.
Why this oneIt usually needs less titration than deutetrabenazine and lets the causative antipsychotic continue.
What limits itSomnolence and QT prolongation; CYP2D6 or CYP3A4 inhibition raises exposure.
FDA-approved for
- tardive dyskinesia (2017)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Tardive dyskinesia | Adults | 40 mg QD | 80 mg QD (after 1 wk); 40–60 mg QD per response | 80 mg QD |
| Chorea associated with Huntington's disease | Adults | 40 mg QD | 80 mg QD (↑20 mg q2wk); 40–60 mg QD per response | 80 mg QD |
Titration Tardive dyskinesia: increase after 1 week. Huntington's chorea: increase in 20 mg increments every 2 weeks.
Renal Undefined
Hepatic Moderate or severe hepatic impairment: 40 mg QD.
Instructions
- With or without food
- Sprinkle: empty capsule over ~1 tbsp soft food (not milk/water), swallow immediately, or swallow capsule whole; do not crush/chew; do not give via enteral tubes
- Known CYP2D6 poor metabolizers: 40 mg QD
Cautions
- QT prolongation (avoid in congenital long QT or QT-prolonging arrhythmias)
- Somnolence/sedation (impaired driving)
- Neuroleptic malignant syndrome
- Parkinsonism
- Hypersensitivity/angioedema
Adverse reactions
- Somnolence/sedation
- Urticaria, rash (Huntington's chorea)
- Insomnia (Huntington's chorea)
Pregnancy Insufficient human data; animal data show increased stillbirths/pup mortality — may cause fetal harm.
Lactation Do not breastfeed during treatment and for 5 days after the final dose.
NO BOXED WARNINGS
Principal riskSomnolence and QT prolongation
Cost, est. cash$3,000–$10,000/month
Generic entry2038 (settlement)
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Valbenazine ballicule
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QT prolongation
