How Tardive Dyskinesia Is Treated

Sometimes reducing causative medication is not an option

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Tardive dyskinesia can often be managed with a variety of strategies. This medication-induced side effect is a movement disorder that can be distressing and may cause substantial limitations in day-to-day life activities.

Treatments include reducing or discontinuing the medication that’s causing tardive dyskinesia, using prescription therapy to reduce the symptoms of tardive dyskinesia, and/or procedural interventions.

Ingrezza (valbenazine) and Austedo (deutetrabenazine) are prescription medications approved by the Food and Drug Administration (FDA) for treating tardive dyskinesia. 

There are several treatment options for tardive dyskinesia

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Home Remedies and Lifestyle 

The medications that can cause tardive dyskinesia include antipsychotics, certain antidepressants, some anti-epileptic drugs (AEDs), and several antiemetics (used to treat nausea and other gastrointestinal symptoms).

Several strategies can reduce the risk of developing tardive dyskinesia and can help prevent it from worsening or becoming permanent. 

Important considerations:

  • If you are using any treatments that can cause tardive dyskinesia, it is important that you take your treatment as prescribed and avoid irregularities in your medication schedule to reduce the risk of side effects or overdose. 
  • You should learn to recognize the signs and symptoms of tardive dyskinesia and talk to your doctor promptly if you start to experience this problem.
  • If you have already been diagnosed with tardive dyskinesia, you should talk to your doctor if the symptoms worsen. 
  • If you want to use any herbal remedies or supplements while taking medications that can cause tardive dyskinesia, be sure to check with your doctor and pharmacist first, as some supplements can interfere with the medications that you are already taking.

If you are diagnosed with tardive dyskinesia, your doctor might reduce the dose of the medication that’s causing it. Tardive dyskinesia often resolves with this approach. 

Some causative medications can be substituted with other prescriptions if tardive dyskinesia develops. Discontinuation and substitution might be done gradually with a schedule specified by your doctor to reduce the chance of withdrawal effects.

While you can develop tardive dyskinesia as a result of taking certain medications, you should not stop taking them or change your dose unless directed to do so by your doctor. Making changes can cause severe problems, including acute psychosis.

Prescriptions

Often, it is necessary to continue to take a prescription medication, even if it causes tardive dyskinesia. This is especially the case if you are being treated for schizophrenia or depression, as symptoms can acutely worsen if medications are reduced or withdrawn.

And sometimes the condition persists even after the causative medication is stopped. If you are in either of these situations, your doctor might prescribe a medication for you to manage your tardive dyskinesia symptoms. 

Medications approved for treating tardive dyskinesia:

  • Ingrezza: This medication is available as a 40 milligram (mg) capsule and an 80 mg capsule. When used for tardive dyskinesia treatment, it is started at a dose of 40 mg once per day and can be maintained at a dose of 40 mg per day or increased to 80 mg per day.
  • Austedo: It is available as 6 mg, 9 mg, and 12 mg tablets. When used for the treatment of tardive dyskinesia, the recommended starting dose is 12 mg/day, with a target dose of 12 to 48 mg/day and a maximum recommended dose of 48 mg/day.

These medications are both vesicular monoamine transporter 2 (VMAT2) inhibitors. They work by controlling the amount of neurotransmitter that can be released in the brain. Tardive dyskinesia is believed to occur due to altered neurotransmitter activity (especially dopamine) in certain regions in the brain. 

Off-Label 

Prior to the approval of Ingrezza and Austedio, tardive dyskinesia was treated with other prescription medications off-label—meaning they are not approved for this indication.

Medications that are sometimes prescribed off-label to treat tardive dyskinesia include:

  • Amantadine: Used for managing symptoms of Parkinson’s disease
  • Clonazepam: An AED
  • Clozapine: An antipsychotic 
  • Keppra: An AED 
  • Propranolol: A medication used to manage high blood pressure 
  • Tetrabenazine: A VMAT2 inhibitor approved for treating symptoms of Huntington’s disease 
  • Cogentin (benztropine), Akineton (biperiden): Anticholinergics used to treat several neurological conditions, including Parkinson’s disease

While the evidence supporting their use in tardive dyskinesia is mixed, these medications are effective for managing symptoms of tardive dyskinesia for some people. Your doctor might prescribe an off-label treatment instead of one of the approved VMAT2 inhibitors to manage tardive dyskinesia based on your symptom response and side effects.

Surgeries and Specialist-Driven Procedures

Some interventional procedures have been beneficial for reducing the symptoms of tardive dyskinesia. These treatments might be appropriate for you if conservative management is ineffective or causes side effects.

Botulinum Toxin Injections

This procedure involves injection of botulinum toxin into a muscle or muscles to induce paralysis and prevent involuntary movements. Botulinum toxin may be effective for the treatment of localized tardive dyskinesia that involves only a few muscle groups.

Generally, the effects of the injections are expected to last for a few months, and the procedure would be repeated if symptoms return.

Deep Brain Stimulation (DBS)

Deep brain stimulation requires a surgical procedure in which a device is implanted in the brain, specifically in the globus pallidus or the subthalamic nucleus. The device provides stimulation to the brain that helps to reduce symptoms of tardive dyskinesia.

Typically, DBS is well tolerated, without frequent side effects. The procedure is invasive, and surveillance of the device and the symptoms may be required after surgery. This surgery is generally considered for medication-resistant tardive dyskinesia.

Complementary and Alternative Medicine (CAM)

In general, alternative therapies have not been found to cure or reverse tardive dyskinesia. However, a multidisciplinary approach, including counseling, can help alleviate anxiety about the condition.

It is important to try to stay healthy, avoiding issues like nutritional deficits. A number of studies have suggested that vitamin E supplementation could potentially prevent the deterioration of tardive dyskinesia, but the evidence for its effect is weak, and doses have not been well established.

Physical exercise can be limited as a result of tardive dyskinesia, but if you can exercise safely, it has not been found to be harmful or to worsen tardive dyskinesia. In fact, physical activity may be helpful for some people. For example, a case report describes the dramatic improvement of tardive dyskinesia symptoms associated with inline skating.

A Word From Verywell

If you are experiencing tardive dyskinesia as a side effect of any medication you are taking, it can limit your ability to function in many ways. The condition causes involuntary movements, and many people feel substantial emotional and social effects as well.

It is important that you discuss your physical symptoms, as well as any feelings you have about this side effect with your doctor. Tardive dyskinesia can often be treated. And it is also important that you talk with a mental health professional who can help you learn strategies to cope with the condition. 

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