What to Know About Austedo (Deutetrabenazine)

Austedo (deutetrabenazine) is a prescription medication approved for use in adults who have movement disorders associated with tardive dyskinesia or chorea related to Huntington’s disease.

Austedo is considered a vesicular monoamine transporter 2 (VMAT2) inhibitor. It reversibly modifies the action of dopamine, serotonin, norepinephrine, and histamine, which are neurotransmitters in the brain. 

Uses 

Chorea Associated with Huntington's Disease

Austedo is approved for the treatment of chorea associated with Huntington’s disease. This medication is used to control chorea, but it does not cure, reverse, or stop the progression of Huntington’s disease or any other condition. If you stop taking Austedo, symptoms of chorea are expected to return. 

Chorea is a type of recurrent, irregular, abrupt involuntary movement that can affect any part of the body. Generally, chorea is painless, but it is visibly noticeable. Huntington’s disease is a hereditary neurodegenerative condition, and chorea is one of its most prominent symptoms. 

Chorea in Huntington’s disease is associated with abnormalities of neurotransmitter activity in the basal ganglia and thalamus—areas of the brain that regulate movement. Austedo is believed to reduce chorea as a result of its effects on neurotransmitter activity.

Tardive Dyskinesia

Austedo is also approved by the FDA to treat tardive dyskinesia, a movement disorder that occurs as a side effect of antipsychotic medications. Tardive dyskinesia can appear similar to chorea. Like chorea, tardive dyskinesia is associated with changes in neurotransmitter function in the basal ganglia. 

The involuntary movements associated with tardive dyskinesia are most common in the face and the mouth. In one clinical study, those treated with Austedo saw a reduction in their AIMS (abnormal involuntary movement scale) scores by 3.3 points compared to 1.4 points in those taking a placebo.

Before Taking 

Before your healthcare provider prescribes Austedo for you, you will have a complete history and physical examination.

Involuntary movements and movement disorders can appear similar to each other, and your practitioner will want to verify that you have chorea (or tardive dyskinesia), and not another movement disorder—such as Parkinson’s disease, tremors, or tics. 

Contraindications 

This medication has not been established as safe for children or for people who are pregnant or breastfeeding.

According to the manufacturer, Austedo can increase the risk of depression and suicidal ideation in people with Huntington’s disease. It is contraindicated if you are currently experiencing suicidal thoughts or if you have depression that is not adequately treated. 

It should be used with caution if you have depression, a history of depression, or a history of suicidal thoughts. While you are taking Austedo, your healthcare provider would periodically monitor you for signs of depression or suicidal thoughts. Monitoring can include questions about depressive symptoms.

You should not take Austedo if you have diminished liver function. And this medication is contraindicated if you are taking monoamine oxidase inhibitors (MAOIs), reserpine, or tetrabenazine.

Precautions 

Austedo can cause extreme tiredness. You should be cautious about driving or using dangerous equipment when taking this medication. Be sure to monitor your tiredness for several weeks after you start taking Austedo before you make a decision about whether or not you can drive.

Overdose 

If you accidentally take too much Austedo, you should seek medical attention immediately. If you experience an overdose, your heart rhythm and vital signs should be monitored in a supervised medical setting. 

An overdose of Austedo can cause adverse reactions, including acute dystonia (sudden involuntary muscle movements), oculogyric crisis (uncontrolled eye movements), nausea and vomiting, sweating, sedation, hypotension (low blood pressure), confusion, diarrhea, hallucinations, rubor (rash, swelling, or redness of the skin), or tremor.

Other VMAT2s

Other VMAT2s include Xenazine (tetrabenazine) and Ingrezza (valbenazine). These medications should not be used together and switching from one VMAT2 to another should be done with careful titration.

• Xenazine (tetrabenazine) is approved for managing chorea in Huntington’s disease.
• Ingrezza (valbenazine) is approved for treating tardive dyskinesia. 

Dosage 

Austedo is available in tablets that come in strengths of 6 milligrams (mg), 9 mg, and 12 mg. The following doses are based on manufacturer recommendations.

You would be prescribed a starting dose of 6 mg per day. If necessary, your healthcare provider might gradually increase your dose by adding 6 mg to your daily dose each week. The maximum recommended daily dosage is 48 mg per day. Doses of 12 mg per day or more should be divided into two equal daily doses. 

If you are switching to Austedo from tetrabenazine, you should stop taking tetrabenazine as directed by your practitioner and start taking Austedo the following day. The manufacturer provides a recommended conversion dosing table.

Modifications 

If you are over the age of 65, you may be more susceptible to side effects when taking Austedo, so the medication should be started at a low dose and maintained at the lowest dose possible.

How to Take and Store 

Take Austedo with food and swallow the tablets whole without chewing, crushing, or breaking them. 

Store Austedo at a temperature of 25 degrees C (77 degrees F) and keep the medication away from light and moisture.

Side Effects 

Austedo can cause side effects, most of which are mild.

In some cases, severe side effects can occur as well. It may be difficult to differentiate some side effects of Austedo from the effects of Huntington's disease, so be sure to tell your healthcare provider about any new symptoms you experience.

Common

The most common side effects of Austedo are:

• Fatigue
• Sleepiness
• Diarrhea
• Dry mouth
• Mood changes
• Confusion
• Rigidity
• Akathisia: A type of involuntary movement accompanied by extreme restlessness
• Agitation
• Restlessness
• Parkinsonism: Muscle stiffness, tremors, impaired coordination

Severe 

Severe side effects of Austedo can be life threatening and may necessitate discontinuing this medication.

Severe side effects include:

• Depression
• Suicidality 
• Neuroleptic malignant syndrome (NMS): High fever, muscle stiffness, confusion, rapid breathing, irregular heart rate, and alterations in blood pressure
• QT prolongation: An alteration in the heart rhythm that can cause symptoms such as dizziness or loss of consciousness
• Hyperprolactinemia
• Binding to melanin-containing tissues 

Warnings and Interactions

The sedative effects of Austedo can be worsened if you use alcohol or medications that are sedating when taking this medication.

Other drug interactions include:

• CYP2D6 inhibitors (paroxetine, fluoxetine, quinidine, bupropion): The maximum recommended dose of Austedo is 36 mg per day when also taking any of these medications. 
• Reserpine: Your healthcare provider will tell you to stop taking reserpine for at least 20 days before you start taking Austedo
• Dopamine antagonists and antipsychotics: There is an increased risk of NMS, parkinsonism, and akathisia when taking Austedo with any of these medications.
• Medications that can cause QT prolongation (including chlorpromazine, haloperidol, thioridazine, ziprasidone, moxifloxacin, quinidine, procainamide, amiodarone, and sotalol): Taking Austedo with these medications can increase your risk of prolonged QT.