deutetrabenazine

Adjunctive therapy

Brands: Austedo, Austedo XR

Last reviewed 2025-09-26

Reviewed by PsychMed Editorial Team.

View details

Quick answers

What is deutetrabenazine?
Deutetrabenazine (Austedo/Austedo XR) is a VMAT2 inhibitor approved for tardive dyskinesia and chorea associated with Huntington disease. Deuterium substitution slows metabolism compared with tetrabenazine, producing steadier plasma exposure with twice-daily IR or once-daily XR dosing.
What is Austedo?
Austedo is a brand name for deutetrabenazine (other brands: Austedo XR).
What is Austedo (deutetrabenazine) used for?
Label indications include: Tardive dyskinesia (adults).
What drug class is Austedo (deutetrabenazine)?
VMAT2 inhibitor that reduces presynaptic dopamine packaging, indicated for tardive dyskinesia and chorea associated with Huntington disease.
What strengths does Austedo (deutetrabenazine) come in?
Immediate-release tablets: 6 mg, 9 mg, 12 mg (administered twice daily with food).

Snapshot

Class: Adjunctive therapy
Common US brands: Austedo, Austedo XR
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-09-26

Clinical Highlights

Deutetrabenazine (Austedo/Austedo XR) is a VMAT2 inhibitor approved for tardive dyskinesia and chorea associated with Huntington disease. Deuterium substitution slows metabolism compared with tetrabenazine, producing steadier plasma exposure with twice-daily IR or once-daily XR dosing. Allows clinicians to reduce hyperkinetic movements while maintaining antipsychotic therapy; randomized trials demonstrate AIMS improvements within six weeks that persist in long-term extensions.

Often chosen when valbenazine is ineffective, poorly tolerated, or not covered; monitor for mood changes owing to the boxed warning for depression and suicidality in Huntington disease.
The compare view and deutetrabenazine evidence feed can support shared decision-making and coordination of VMAT2 titration alongside antipsychotic adjustments; the schizophrenia hub includes related long-term tardive dyskinesia resources.
Tardive dyskinesia (adults) (FDA 2017)
Generic: Brand-only as of 2025.

Dosing & Formulations

Immediate-release tablets: 6 mg, 9 mg, 12 mg (administered twice daily with food). Extended-release tablets: 6 mg, 12 mg, 24 mg taken once daily with food.

Immediate-release (label): begins at 6 mg once daily with food; titrate by 6 mg/day at weekly intervals (as divided twice-daily doses) to a typical 12 mg twice-daily target; maximum 48 mg/day.
Extended-release (label): begins at 12 mg once daily with food; titrate by 6 mg/day each week up to 48 mg once daily.
Label limits total daily dose to 36 mg/day in poor CYP2D6 metabolizers or when co-administered with strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, bupropion, quinidine).
Contraindicated in hepatic impairment. If therapy is interrupted for >1 week, label recommends restarting titration; interruptions ≤7 days may resume the prior dose.

Monitoring & Risks

Boxed warning: Depression and suicidality in patients with Huntington’s disease (monitor mood in all patients). Somnolence/fatigue: Most frequent; caution regarding driving or machinery.

Diarrhea: Usually mild and self-limited.
Dry mouth: Hydration and oral hygiene can help.
Nasopharyngitis or URTI: Observed in clinical trials.
Insomnia/restlessness: Sleep quality is monitored and dosing timing can be adjusted if needed.

Drug Interactions

Strong CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion, quinidine) increase exposure—limit dose to 36 mg/day; monitoring for QTc effects and sedation is important. Contraindicated with MAOIs, tetrabenazine, or reserpine due to excessive monoamine depletion.

Additive sedation with alcohol, benzodiazepines, opioids, or other CNS depressants increases fall risk; fall-risk counseling is common.
Caution is warranted with QT-prolonging antipsychotics (ziprasidone, haloperidol, methadone); ECG monitoring may be considered.

Practice Notes

Evaluate tardive dyskinesia severity (AIMS or equivalent) at baseline and follow-up visits to document benefit. Screen for mood changes, depression, or suicidality at each encounter; involve caregivers when available.

Baseline hepatic function is typically checked (therapy contraindicated in hepatic impairment), and baseline ECG is often considered in patients with cardiac risk factors or when using CYP2D6 inhibitors.
Doses are taken with food to improve absorption and reduce gastrointestinal upset; XR tablet shells may pass in stool.