Tetrabenazine (Nitoman/Xenazine)

Primer

Tetrabenazine (Trade name: Nitoman/Xenazine) is a vesicular monoamine transporter 2 (VMAT2) inhibitor used in the treatment of Huntington's Disease and tardive dyskinesia.

Pharmacokinetics

Pharmacokinetics of Tetrabenazine

Absorption
Distribution
Metabolism
Elimination
Half-life

Tetrabenazine: Cytochrome P450 Metabolism

Substrate of (Metabolized by)
Induces
Inhibits

Pharmacodynamics

Mechanism of Action

Toxicity

Indications

Dosing

Dosing for Tetrabenazine

Starting
Titration
Maximum
Taper

Formulations

  • Tetrabenazine comes in

Monitoring

Contraindications

Tetrabenazine should not be taken under the following circumstances:

  • Known hypersensitivity to tetrabenazine
  • In patients with currently untreated or inadequately treated episodes of clinical depression
  • If administered together with a monoamine oxidase inhibitor (MAOI)
    • At least 14 days should elapse between the discontinuation of an MAOI and initiation of treatment with tetrabenazine, and vice versa (between the discontinuation of tetrabenazine and the initiation of treatment with an MAOI)
  • Impaired hepatic function
  • In patients taking reserpine

Absolute

Relative

Drug-Drug Interactions

Side Effects

  • Tetrabenazine can cause depression as it causes a depletion of amines, therefore, untreated depression is a contraindication.

Adverse Events

Clinical Pearls

Special Populations

Geriatric

Pediatric

Obstetric and Fetal

Medically Ill

Resources