Home Drug Guide Valbenazine

Drug Guide

Generic Name

Valbenazine

Brand Names Ingrezza

Classification

Therapeutic: Antipsychotic, used for movement disorders

Pharmacological: Selective vesicular monoamine transporter 2 (VMAT2) inhibitor

FDA Approved Indications

  • Tardive Dyskinesia

Mechanism of Action

Valbenazine inhibits VMAT2, reducing the uptake of monoamines into synaptic vesicles, which decreases monoamine release and alleviates hyperkinetic movement disorders like tardive dyskinesia.

Dosage and Administration

Adult: Start at 40 mg once daily. May increase to 80 mg once daily based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower doses due to age-related sensitivity.

Renal Impairment: No dosage adjustment necessary for mild to moderate impairment; use caution in severe impairment.

Hepatic Impairment: Use caution; no specific dosage adjustment established.

Pharmacokinetics

Absorption: Rapidly absorbed with peak concentrations in 1-3 hours.

Distribution: Widely distributed; protein binding approximately 99%.

Metabolism: Primarily hepatic via CYP3A4 and CYP2D6 pathways.

Excretion: Excreted mainly in feces and urine.

Half Life: Approximately 15 hours.

Contraindications

  • Hypersensitivity to valbenazine
  • Concurrent use with reversible monoamine oxidase inhibitors (MAOIs).

Precautions

  • Use with caution in patients with cardiovascular disease, suicidal ideation, or history. Monitor for tardive dyskinesia worsening.

Adverse Reactions - Common

  • Sleepiness or sedation (Common)
  • Headache (Common)
  • decreased blood pressure (hypotension) (Common)

Adverse Reactions - Serious

  • QT prolongation (Serious)
  • Neuroleptic malignant syndrome (Serious)
  • Tardive dyskinesia worsening (Serious)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole) may increase valbenazine levels.
  • CYP3A4 inducers (e.g., rifampin) may decrease efficacy.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor movement symptoms, mental status, blood pressure, ECG for QT prolongation.

Diagnoses:

  • Risk of falls due to sedation or hypotension.
  • Impaired mobility related to movement disorder.

Implementation: Administer once daily with or without food.

Evaluation: Assess improvement or worsening of TD symptoms; monitor cardiovascular status.

Patient/Family Teaching

  • Take medication as prescribed, at the same time each day.
  • Report signs of abnormal movements, dizziness, or fainting.
  • Avoid alcohol and other CNS depressants.
  • Inform about potential for QT prolongation and avoid concurrent use of other QT-prolonging drugs.

Special Considerations

Black Box Warnings:

  • QT prolongation and sudden death in overdose.
  • Potential for neuroleptic malignant syndrome.

Genetic Factors: Consider CYP2D6 metabolizer status for dose adjustments.

Lab Test Interference: None noted.

Overdose Management

Signs/Symptoms: Drowsiness, sedation, hypotension, QT prolongation.

Treatment: Supportive care, monitor cardiac status, and provide symptomatic treatment. No specific antidote.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable through expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.