Chorea Treatments

Living with tardive dyskinesia (TD) can be an incredibly challenging and isolating experience. The uncontrollable, repetitive movements of the face, tongue, trunk or limbs are not just physical, they can profoundly impact self-esteem, social interactions, and overall quality of life. For many years, these movements, often a side effect of necessary medications for mental health, had no approved treatment. The introduction of Ingrezza (valbenazine) marked a turning point, offering the first FDA-approved medication specifically designed to manage this condition.

Ingrezza is a newer, specialized prescription medication that belongs to a class of drugs called vesicular monoamine transporter 2 (VMAT2) inhibitors. It is not a medication for the underlying mental health condition, but a targeted therapy focused solely on reducing the involuntary movements of TD. For patients and their loved ones, understanding how Ingrezza works provides hope and a clear path toward regaining control and confidence.

What does Ingrezza do?

Ingrezza is approved by the U.S. Food and Drug Administration (FDA) for the treatment of adults with tardive dyskinesia. TD is characterized by involuntary movements that can include:

• Lip smacking, puckering or pursing
• Grimacing or frowning
• Rapid eye blinking
• Tongue protrusion
• Involuntary movements of the arms, legs, fingers or toes

Ingrezza aims to reduce the severity and frequency of unwanted movements, offering significant relief to improve speaking, eating, and social engagement, though it is not a cure.

Clinical studies have shown Ingrezza to be effective for many patients. In these trials, individuals taking Ingrezza experienced a significant reduction in their involuntary movements compared to those taking a placebo, with many noticing improvements within a few weeks of starting treatment (Neurocrine Biosciences, Inc., 2023).

How does Ingrezza work?

To understand how Ingrezza works, it helps to know a little about a key chemical messenger in the brain called dopamine. Dopamine is a neurotransmitter that plays a vital role in coordinating movement. Tardive dyskinesia is believed to occur when long-term use of certain medications (like antipsychotics) causes the dopamine receptors in the brain to become overly sensitive. This leads to an excess of dopamine signaling, which is like having the “volume” turned up too high in the part of the brain that controls movement, resulting in the involuntary muscle activity of TD.

Ingrezza works by targeting a protein in the brain called VMAT2. Think of VMAT2 as a transporter responsible for packaging dopamine into storage containers (vesicles) within nerve cells before it can be released. Ingrezza is a VMAT2 inhibitor, which means it partially blocks this transporter.

By gently “putting the brakes” on VMAT2, Ingrezza reduces the amount of dopamine that gets loaded into these storage containers. As a result, less dopamine is released from the nerve cells. This helps to turn down the “volume” of the overactive dopamine signals, which calms the excessive nerve activity and leads to a reduction in the involuntary movements of TD. This is a highly selective mechanism designed to rebalance the movement control system in the brain without interfering with the medications used to treat the underlying psychiatric condition.

Ingrezza side effects

Like any medication, Ingrezza has potential side effects. The most common ones are generally mild, but it’s important to discuss any concerns with your healthcare provider.

The most common side effect of Ingrezza is sleepiness or drowsiness (somnolence). Other common side effects may include:

• Changes in balance or coordination
• Dry mouth
• Constipation
• Blurred vision
• Dizziness

QT prolongation, a change in heart rhythm, is a less common but important side effect. Your doctor will assess its safety if you have a pre-existing heart condition.

Ingrezza can cause parkinsonism-like symptoms (tremors, stiffness, trouble moving); report these to your doctor. Do not drive or operate machinery until you know its effects. Seek immediate medical help for allergic reactions (hives, facial/tongue swelling, breathing issues) (Mayo Clinic, 2024).

Ingrezza dosage

Ingrezza is a once-daily oral capsule, taken with or without food. Doctors typically begin with a lower dose for the first week, then increase to the therapeutic dose. This gradual approach minimizes side effects as the body adjusts.

Ingrezza typically doesn’t require routine blood tests. However, your doctor will monitor your tardive dyskinesia symptoms and inquire about side effects, especially sleepiness. For patients with specific heart conditions, an ECG may be recommended to monitor heart rhythm.

Inform your doctor of all medications, as some may interact with Ingrezza. Liver problems (moderate to severe) may require dose adjustments.

Does Ingrezza have a generic version?

No, Ingrezza (valbenazine) is a brand-name medication and there is no generic version currently available in the United States. However, international versions may exist in other markets. As a newer drug, it is protected by patents that prevent other companies from manufacturing a generic equivalent. When these patents expire in the future, the FDA may approve generic versions, which could provide more affordable options.

Conclusion

For many years, living with tardive dyskinesia meant living without an approved treatment. Ingrezza has fundamentally changed that reality, offering a targeted, effective way to manage the involuntary movements that can be so disruptive to a person’s life. By precisely regulating dopamine activity in the brain, it helps to restore balance and reduce symptoms, often leading to a significant improvement in confidence and well-being.

While it has potential side effects, its safety profile is well-established, and risks can be managed with close medical supervision. If you or a loved one is affected by TD, having a conversation with a healthcare provider about Ingrezza is an empowering step toward taking control of the condition and improving your quality of life.

References

1. Mayo Clinic. (2024). Valbenazine (Oral Route). Retrieved from https://www.mayoclinic.org/drugs-supplements/valbenazine-oral-route/side-effects/drg-20406212
2. Neurocrine Biosciences, Inc. (2023). INGREZZA® (valbenazine) capsules Prescribing Information. U.S. Food and Drug Administration. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/209241s014lbl.pdf