WARNING

Tetrabenazine is a medication primarily used to treat Huntington’s disease and other hyperkinetic movement disorders. While it can be effective in managing symptoms, there are several risks associated with its use:

• Depression and Suicidal Thoughts: Tetrabenazine can increase the risk of depression and suicidal thoughts or behaviors, particularly in patients with a history of mental health disorders.
• Parkinsonism: Tetrabenazine may cause symptoms similar to Parkinson’s disease, such as tremors, stiffness, and difficulty with movement.
• Neuroleptic Malignant Syndrome (NMS): In rare cases, tetrabenazine can lead to NMS, a potentially life-threatening condition characterized by high fever, muscle rigidity, confusion, and other symptoms.
• QT Prolongation: Tetrabenazine may prolong the QT interval in the heart’s electrical cycle, potentially leading to abnormal heart rhythms, including a serious condition called torsades de pointes.
• Drowsiness and Fatigue: Tetrabenazine can cause drowsiness and fatigue, which may impair a person’s ability to operate machinery or drive safely.
• Worsening of Movement Disorders: In some cases, tetrabenazine may worsen certain movement disorders or induce new ones.
• Parkinsonism-Hyperpyrexia Syndrome (PHS): This syndrome, characterized by fever, altered consciousness, and other symptoms, can occur when tetrabenazine is suddenly stopped, particularly in patients with Parkinson’s disease.

It’s essential for patients to discuss these risks thoroughly with their healthcare provider before starting tetrabenazine and to report any concerning symptoms promptly during treatment. Additionally, medical supervision is crucial for proper dosing and monitoring for adverse effects.

Why is this medication prescribed?

Tetrabenazine is typically prescribed for the treatment of hyperkinetic movement disorders, notably Huntington’s disease. It works by reducing the levels of certain chemicals in the brain that are involved in controlling movement.

When prescribed, tetrabenazine is usually used as part of a comprehensive treatment plan aimed at managing symptoms such as involuntary movements (chorea), muscle stiffness, and difficulties with coordination and balance.

How should this medicine be used?

The dosing and administration of tetrabenazine should be carefully managed by a healthcare professional, typically a neurologist or movement disorder specialist. Here are some general guidelines for its use:

• Starting Dose: Treatment usually begins with a low dose, which is gradually increased over time to achieve the desired therapeutic effect while minimizing side effects.
• Dosage Adjustment: The dosage of tetrabenazine may need to be adjusted based on individual response and tolerance to the medication. Healthcare providers will monitor patients closely during this titration process.
• Frequency: Tetrabenazine is typically taken orally, usually two to three times a day, depending on the specific regimen prescribed by the healthcare provider.
• Timing: It is important to take tetrabenazine at the same times each day to maintain consistent levels of the medication in the body.
• Food Interaction: Tetrabenazine can be taken with or without food. However, taking it with food may help reduce the risk of gastrointestinal side effects such as nausea.
• Duration: Tetrabenazine is usually taken on a long-term basis to manage chronic movement disorders. Stopping the medication abruptly can lead to withdrawal symptoms or worsening of symptoms, so any changes in dosage or discontinuation should be done under medical supervision.
• Monitoring: Patients should be monitored regularly by their healthcare provider to assess the effectiveness of the medication, manage any side effects, and adjust the dosage as needed.

It’s crucial for patients to follow their healthcare provider’s instructions carefully and to report any concerning symptoms or side effects promptly during treatment with tetrabenazine.

Other uses for this medicine

Some off-label uses include:

• Tourette Syndrome: Tetrabenazine may be used to help manage tics associated with Tourette syndrome, although its efficacy for this indication is not well-established.
• Tardive Dyskinesia: In some cases, tetrabenazine may be prescribed off-label to manage tardive dyskinesia, a condition characterized by involuntary movements often caused by long-term use of certain medications.
• Dystonia: Tetrabenazine might also be used off-label to alleviate symptoms of dystonia, a movement disorder characterized by sustained or repetitive muscle contractions.

What special precautions should I follow?

Regarding special precautions for tetrabenazine use, it’s essential to follow these guidelines:

• Medical History: Before starting tetrabenazine, inform your healthcare provider about any medical conditions you have, especially depression, suicidal thoughts or behaviors, Parkinson’s disease, heart problems, or liver disease.
• Medication Interactions: Tetrabenazine can interact with other medications, including antidepressants, antipsychotics, and drugs that prolong the QT interval. Inform your healthcare provider about all medications, supplements, and herbal products you are taking to avoid potential interactions.
• Pregnancy and Breastfeeding: Tetrabenazine may harm an unborn baby, so it’s important to use effective birth control during treatment. If you are pregnant or planning to become pregnant, discuss the risks and benefits of tetrabenazine with your healthcare provider. Tetrabenazine may also pass into breast milk, so breastfeeding while taking this medication is not recommended.
• Suicidal Thoughts: Tetrabenazine may increase the risk of suicidal thoughts or behaviors, particularly in individuals with a history of depression or mental health disorders. Contact your healthcare provider immediately if you experience worsening depression, mood changes, or suicidal thoughts while taking tetrabenazine.
• Driving and Operating Machinery: Tetrabenazine may cause drowsiness and fatigue, which can impair your ability to drive or operate machinery safely. Avoid these activities until you know how tetrabenazine affects you.
• Dose Adjustment and Monitoring: Tetrabenazine dosing may need to be adjusted based on individual response and tolerance. Your healthcare provider will monitor you closely for side effects and may perform regular assessments to evaluate the medication’s effectiveness.

Following these precautions can help ensure safe and effective use of tetrabenazine under the guidance of a healthcare professional.

What special dietary instructions should I follow?

Regarding special dietary instructions for tetrabenazine, there are no specific dietary restrictions associated with its use. However, taking tetrabenazine with food may help reduce the risk of gastrointestinal side effects such as nausea. It’s generally recommended to follow a balanced diet and stay hydrated while taking this medication.

What should I do if I forget a dose?

If you forget to take a dose of tetrabenazine, take it as soon as you remember, unless it is close to the time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up. If you’re unsure about what to do, consult your healthcare provider or pharmacist for guidance. It’s important to maintain a consistent dosing schedule to ensure the medication remains effective in managing your symptoms.

What side effects can this medication cause?

Tetrabenazine, like any medication, can cause side effects, although not everyone experiences them. Common side effects of tetrabenazine include:

• Drowsiness: Tetrabenazine may cause drowsiness or sleepiness, which can impair your ability to perform tasks requiring alertness, such as driving or operating machinery.
• Fatigue: Some people may experience fatigue or tiredness while taking tetrabenazine.
• Depression: Tetrabenazine may increase the risk of depression or worsen existing depression in some individuals.
• Parkinsonism: Symptoms resembling those of Parkinson’s disease, such as tremors, stiffness, and difficulty with movement, can occur with tetrabenazine use.
• Restlessness: Tetrabenazine may cause feelings of restlessness or agitation in some people.
• Insomnia: Difficulty falling asleep or staying asleep may occur as a side effect of tetrabenazine.
• Nausea: Tetrabenazine can cause nausea or stomach discomfort, particularly when first starting the medication.
• Dizziness: Some individuals may experience dizziness or lightheadedness while taking tetrabenazine.
• Irregular Heartbeat: Tetrabenazine may prolong the QT interval in the heart’s electrical cycle, leading to abnormal heart rhythms in some cases.
• Weight Gain: Weight gain has been reported as a side effect of tetrabenazine use.
• Akathisia: Tetrabenazine may cause a condition called akathisia, characterized by feelings of inner restlessness and an inability to sit still.
• Suicidal Thoughts: In rare cases, tetrabenazine may increase the risk of suicidal thoughts or behaviors, particularly in individuals with a history of depression or mental health disorders.

It’s important to note that this list is not exhaustive, and other side effects may occur. Additionally, some side effects may require medical attention. If you experience any unusual or bothersome symptoms while taking tetrabenazine, contact your healthcare provider for guidance. They can help determine whether adjustments to your treatment plan are necessary.

What should I know about storage and disposal of this medication?

When it comes to the storage and disposal of tetrabenazine, here’s what you should know:

• Storage: Store tetrabenazine at room temperature away from moisture, heat, and light. Keep the medication in its original container, tightly closed, and out of reach of children and pets.
• Disposal: Dispose of unused or expired tetrabenazine safely according to local regulations or guidelines. Do not flush medications down the toilet or pour them down the drain unless instructed to do so. Instead, consult your pharmacist or local waste disposal company for proper disposal instructions.

In case of emergency/overdose

In case of emergency or overdose of tetrabenazine, take the following steps:

• Seek Medical Attention: If you suspect an overdose or experience severe symptoms such as difficulty breathing, loss of consciousness, severe dizziness, or irregular heartbeat, seek immediate medical attention by calling emergency services or going to the nearest emergency room.
• Poison Control: You can also contact your local poison control center or national poison helpline for guidance on what to do next. They can provide advice on managing the situation and may recommend additional steps to take.
• Do Not Drive: If you or someone else has taken too much tetrabenazine and experiences drowsiness, dizziness, or other impairments, do not attempt to drive or operate machinery. Wait until it is safe to do so or seek assistance from someone else.

What other information should I know?

• Regular Monitoring: Your healthcare provider will likely monitor you regularly while taking tetrabenazine to assess its effectiveness and monitor for any potential side effects or complications. Attend all scheduled appointments and inform your doctor of any changes in your condition.
• Compliance: Take tetrabenazine exactly as prescribed by your healthcare provider. Do not change the dosage or stop taking the medication without consulting your doctor, as doing so could worsen your symptoms or lead to withdrawal effects.
• Interactions: Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with tetrabenazine and affect its effectiveness or increase the risk of side effects.
• Patient Education: Educate yourself about tetrabenazine, including its uses, potential side effects, and precautions. Ask your healthcare provider any questions you may have to ensure you have a clear understanding of your treatment plan.

By following these guidelines and staying informed about tetrabenazine, you can ensure their safe and effective use as part of your treatment plan.