valbenazine

Adjunctive therapy

Brands: INGREZZA

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is valbenazine?
Valbenazine (Ingrezza) is an oral vesicular monoamine transporter 2 (VMAT2) inhibitor indicated for adults with tardive dyskinesia who remain on dopamine receptor–blocking agents.
What is INGREZZA?
INGREZZA is a brand name for valbenazine.
What is INGREZZA (valbenazine) used for?
Label indications include: Tardive dyskinesia.
What drug class is INGREZZA (valbenazine)?
Vesicular monoamine transporter 2 (VMAT2) inhibitor.
What strengths does INGREZZA (valbenazine) come in?
Hard gelatin capsules: 40 mg, 60 mg, 80 mg (administer once daily with or without food).

Snapshot

Class: Adjunctive therapy
Common US brands: INGREZZA
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Tardive dyskinesia.

View labelExact

Clinical Highlights

Valbenazine (Ingrezza) is an oral vesicular monoamine transporter 2 (VMAT2) inhibitor indicated for adults with tardive dyskinesia who remain on dopamine receptor–blocking agents. Randomized trials demonstrate clinically meaningful Abnormal Involuntary Movement Scale (AIMS) reductions within two weeks that persist through 48-week extensions, supporting guideline placement as first-line VMAT2 therapy despite access hurdles such as prior authorization and copay costs.

Frequently preferred over deutetrabenazine because of once-daily dosing and a modest monitoring burden; financial assistance is often required to initiate or continue therapy.
The compare view and the valbenazine evidence feed can help contrast dosing logistics, QT monitoring needs, and adverse effect profiles when reauthorizing therapy.
Tardive dyskinesia (adults) (FDA 2017)
Generic: No generic formulation available as of 2025.

Dosing & Formulations

Hard gelatin capsules: 40 mg, 60 mg, 80 mg (administer once daily with or without food). Initiate 40 mg once daily for 7 days, then increase to 80 mg once daily if tolerated.

Limit to 40 mg once daily with strong CYP3A4 inhibitors or in moderate/severe hepatic impairment (Child-Pugh B/C); avoid use in Child-Pugh C when risk outweighs benefit.
Avoid strong CYP3A4 inducers (rifampin, carbamazepine, St. John’s wort) and consider 40 mg maintenance in CYP2D6 poor metabolizers or with strong CYP2D6 inhibitors.
Not recommended in severe renal impairment (eGFR <30 mL/min/1.73 m^2).

Monitoring & Risks

Somnolence: Warn patients about driving or operating machinery until they know their response. Dry mouth: Usually mild; encourage hydration and oral care.

Fatigue and gait instability: Monitor older adults for falls—consider dose reduction if problematic.
Dose-dependent QTc prolongation (mean ~6 msec at 80 mg); obtain baseline and follow-up ECGs when other QT-prolonging risks are present.
Rare parkinsonism or akathisia; reduce dose or discontinue if new movement symptoms emerge.
Potential for hypersensitivity reactions and angioedema reported in post-marketing surveillance.

Drug Interactions

Contraindicated with strong CYP3A4 inducers (rifampin, carbamazepine, phenytoin, St. John’s wort) due to markedly reduced exposure. Strong CYP3A4 inhibitors (ketoconazole, clarithromycin) and strong CYP2D6 inhibitors (paroxetine, fluoxetine, quinidine) increase exposure—limit to 40 mg/day and monitor for somnolence and QTc effects.

Additive QT prolongation with other QT-active agents (e.g., ziprasidone, methadone, class Ia/III antiarrhythmics); avoid or monitor closely.
Avoid concomitant reserpine or other VMAT2 inhibitors because of theoretical additive monoamine depletion.

Practice Notes

Document baseline AIMS score and reassess every 4–12 weeks to gauge benefit and guide payer renewals. Maintain the underlying antipsychotic when clinically feasible; valbenazine treats TD symptoms rather than the primary psychiatric disorder.

If two or more consecutive doses are missed, instruct patients to restart at 40 mg for one week before re-escalating.
Discuss pregnancy registry participation and lactation data limitations when applicable.
Coordinate TD management with clinic tardive dyskinesia protocols and document functional improvement to sustain payer approval.

References

INGREZZA (valbenazine) prescribing information — DailyMed (2025)
Kinect 3: A Phase 3 Randomized, Double Blind, Placebo Controlled Trial OF Valbenazine FOR Tardive Dyskinesia — American Journal of Psychiatry (2017)
A Long Term, Open Label Study OF Valbenazine FOR Tardive Dyskinesia — CNS Spectrums (2021)
Tardive dyskinesia: placing vesicular monoamine transporter type 2 (VMAT2) inhibitors into clinical perspective — Expert Review of Neurotherapeutics (2018)