Ingrezza (Valbenazine)

Mechanism of Action: NBI-98854 is a potent, highly selective, VMAT2 inhibitor that is effective in regulating the levels of dopamine release during nerve communication, while at the same time having minimal impact on the other monoamines. This selectivity may reduce the likelihood of “off-target” side effects. Additionally, we have designed this novel compound to provide low, sustained, plasma and brain concentrations of the active drug to minimize the potential side effects associated with excessive dopamine depletion. With these features, NBI-98854 is anticipated to be well tolerated in patients. –Neurocrine Biosciences

Indications: Tardive Dykenisa and doing clinical trials for Tourettes Syndrome

Interactions: Do not take the following medications with Ingrezza:

  • Monoamine oxidase inhibitors (MAOIs) (e.g., linezolid, selegiline, isocarboxazid, phenelzine)
  • Strong CYP3A4 inducers (e.g., itraconazole, ketoconazole, clarithromycin)

Dose changes may be needed when taking Ingrezza with:

  • Strong CYP3A4 inhibitors (e.g., indinavir for HIV, rifampin, carbamazepine, phenytoin, St. John’s wort): Your healthcare provider will reduce your Ingrezza dose when taking these medications.
  • Strong CYP2D6 inhibitors (e.g., antidepressants such as fluoxetine, paroxetine, quinidine): Your healthcare provider may reduce your dose of Ingrezza if you take these medications.
  • Digoxin: Your healthcare provider should monitor digoxin concentrations and adjust the digoxin dose as necessary.

–Very Well Mind

Dosing:

    • The initial dosage of valbenazine is 40 mg once daily. After one week, the recommended dosage of valbenazine is 80 mg once daily.
    • Valbenazine can be taken with or without food.
    • The recommended dosage for patients with moderate or severe hepatic impairment is 40 mg once daily.
    • The recommended dosage for known CYP2D6 poor metabolizers is 40 mg once daily.

–Drugs.com

Pros

  • Valbenazine off-label is used to treat tics and chorea
  • Coverage may be easier than with deutetrabenazine
  • Although no TD is great, some report mild to significant improvement with treatment. The advantages of valbenazine include once-daily dosing and a rapid onset of effect within 2 weeks of treatment initiation. –Pub Med

Cons

  • Valbenazine can still cause motor and balance issues, s/e of dizziness, Parkinsonism, drooling, and fall risks. Some patients report weight gain and a lot of side effects…may cause QT prolongation and caution with liver problems/MANY rx interactions –Drugs.com
  • Limited or unknown data if it’s safe for children, pregnancy/breastfeeding
  • Coverage/co-pays can still be difficult but have saving plans and resources

Additional Information

Official Medication Website: Ingrezza (Valbenazine)

Ingrezza vs Austedo

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