Home Drug Guide Deutetrabenazine

Drug Guide

Generic Name

Deutetrabenazine

Brand Names Austedo, Austedo XR

Classification

Therapeutic: Antidote for movement disorders, specifically tardive dyskinesia and Huntington's disease chorea

Pharmacological: Vesicular Monoamine Transporter 2 (VMAT2) inhibitor

FDA Approved Indications

Tardive dyskinesia in adults
Huntington's disease chorea in adults

Mechanism of Action

Deutetrabenazine inhibits VMAT2, leading to depletion of dopamine in presynaptic neurons, which helps reduce abnormal movements.

Dosage and Administration

Adult: Starting dose typically 6 mg twice daily, titrated based on response and tolerability up to 48 mg/day for tardive dyskinesia and up to 36 mg/day for Huntington's chorea.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower doses with careful titration.

Renal Impairment: Adjust dose based on severity; consult specific guidelines.

Hepatic Impairment: Use with caution; may require dose adjustments due to altered metabolism.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Extensively protein-bound.

Metabolism: Primarily hepatic via CYP2D6; active metabolites.

Excretion: Excreted in urine and feces.

Half Life: Approximately 9 to 10 hours.

Contraindications

Concurrent use with/within 14 days of monoamine oxidase inhibitors (MAOIs)
History of depression, suicidal ideation, or untreated depression

Precautions

Monitor for depression, parkinsonism, and suicidality; cautious use in hepatic impairment; avoid in pregnancy unless benefits outweigh risks.

Adverse Reactions - Common

Somnolence (Common)
Decreased blood pressure (Common)
Fatigue (Common)
Diarrhea (Common)

Adverse Reactions - Serious

Depression or worsening depression (Less common)
Suicidal thoughts or behavior (Less common)
Parkinsonism or other extrapyramidal symptoms (Less common)
QT prolongation (Less common)

Drug-Drug Interactions

CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) — may increase plasma levels of deutetrabenazine
Other medications affecting dopamine levels

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for mood changes, suicidal ideation, blood pressure, and movement disorders.

Diagnoses:

Risk for depression
Impaired mobility
Risk for falls

Implementation: Administer with food to reduce gastrointestinal upset; monitor vital signs and mental status regularly.

Evaluation: Assess reduction in chorea or dyskinesia and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report any new or worsening depression, suicidal thoughts, or unusual movements.
Avoid alcohol and sedatives unless directed by a healthcare provider.
Be aware of potential side effects such as drowsiness or low blood pressure.

Special Considerations

Black Box Warnings:

Exposure to depression and suicidality in patients taking deutetrabenazine and tetrabenazine.
Potential for increased depression and suicidal thoughts, especially in patients with a history of depression.

Genetic Factors: CYP2D6 poor metabolizers may have increased drug levels; consider dose adjustments.

Lab Test Interference: May affect assessments of liver function tests.

Overdose Management

Signs/Symptoms: Drowsiness, agitation, dystonia, severe hypotension, or extrapyramidal symptoms.

Treatment: Supportive care; activated charcoal if ingestion is recent; no specific antidote.

Storage and Handling

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

Stability: Stable for up to 24 months when stored properly.