Dosing & Uses
Dosage Forms & Strengths
tablet
- 6mg
- 9mg
- 12mg
Chorea With Huntington Disease
Initial dose when not being switched from tetrabenazine: 6 mg PO qDay
May increase dose at weekly intervals in increments of 6 mg/day; not to exceed 48 mg/day
Administer doses ≥12 mg/day in 2 divided doses
Also see Administration for doses when switching from tetrabenazine
Tardive Dyskinesia (TD)
Initial dose when not being switched from tetrabenazine: 6 mg PO BID
May increase dose at weekly intervals in increments of 6 mg/day; not to exceed 48 mg/day
Also see Administration for doses when switching from tetrabenazine
Dosage Modifications
Strong CYP2D6 inhibitors
- Deutetrabenazine daily dose: Not to exceed 36 mg/day (maximum single dose of 18 mg)
- Examples of strong CYP2D6 inhibitors include quinidine and antidepressants (eg, paroxetine, fluoxetine, bupropion)
Poor CYP2D6 metabolizers
- Deutetrabenazine daily dose: Not to exceed 36 mg/day (maximum single dose of 18 mg)
Hepatic impairment
- Contraindicated
- Effect of hepatic impairment on the pharmacokinetics of deutetrabenazine and its primary metabolites has not been studied
- In a clinical study conducted with tetrabenazine, a closely related VMAT2 inhibitor, there was a large increase in exposure to tetrabenazine and its active metabolites
- The clinical significance of this increased exposure has not been assessed, but because of concerns for a greater risk for serious adverse reactions, it is contraindicated
Dosing Considerations
Determine dose for each patient based on reduction of chorea or tardive dyskinesia and on tolerability
For patients at risk for QT prolongation, assess QT interval before and after increasing doses to >24 mg/day
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (11)
- isocarboxazid
isocarboxazid, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- linezolid
linezolid, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI. If linezolid must be used, discontinue deutetrabenazine and monitor for adverse effects. Deutetrabenazine may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
- methylene blue
methylene blue, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI. If methylene blue must be used emergently, discontinue deutetrabenazine and monitor for adverse effects. Deutetrabenazine may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- phenelzine
phenelzine, deutetrabenazine. Either increases levels of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- rasagiline
rasagiline, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- safinamide
safinamide, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- selegiline
selegiline, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- selegiline transdermal
selegiline transdermal, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- tetrabenazine
tetrabenazine, deutetrabenazine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Do not use these drugs concomitantly. Deutetrabenazine may be initiated the day after discontinuing tetrabenazine.
- tranylcypromine
tranylcypromine, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- valbenazine
deutetrabenazine, valbenazine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Do not use these drugs concomitantly.
Serious - Use Alternative (55)
- artemether/lumefantrine
deutetrabenazine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
bedaquiline and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine
deutetrabenazine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- crizotinib
crizotinib and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
deutetrabenazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
deutetrabenazine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
deutetrabenazine and eribulin both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
deutetrabenazine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
deutetrabenazine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
deutetrabenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
deutetrabenazine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- flecainide
deutetrabenazine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
deutetrabenazine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
- goserelin
deutetrabenazine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.
- histrelin
deutetrabenazine and histrelin both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- iobenguane I 131
deutetrabenazine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoflurane
deutetrabenazine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
deutetrabenazine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- lenvatinib
deutetrabenazine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.
- leuprolide
deutetrabenazine and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
deutetrabenazine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- methadone
deutetrabenazine and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- metoclopramide intranasal
deutetrabenazine, metoclopramide intranasal. Either decreases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midostaurin
deutetrabenazine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- ondansetron
deutetrabenazine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- osimertinib
deutetrabenazine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
deutetrabenazine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
deutetrabenazine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.
- paroxetine
deutetrabenazine and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.
- pasireotide
deutetrabenazine and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
deutetrabenazine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
deutetrabenazine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
deutetrabenazine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- propafenone
deutetrabenazine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
ribociclib increases toxicity of deutetrabenazine by QTc interval. Avoid or Use Alternate Drug.
- safinamide
deutetrabenazine decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.
- saquinavir
deutetrabenazine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
deutetrabenazine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
deutetrabenazine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
deutetrabenazine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- thiothixene
deutetrabenazine and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.
- trazodone
deutetrabenazine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- triptorelin
deutetrabenazine and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.
- vandetanib
deutetrabenazine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
deutetrabenazine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (223)
- abiraterone
abiraterone will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- acetazolamide
acetazolamide and deutetrabenazine both increase sedation. Use Caution/Monitor.
- albuterol
albuterol and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- alfuzosin
alfuzosin and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- alprazolam
alprazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- amiodarone
amiodarone and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- amitriptyline
amitriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor. - amobarbital
amobarbital and deutetrabenazine both increase sedation. Use Caution/Monitor.
- amoxapine
amoxapine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and amoxapine both increase QTc interval. Use Caution/Monitor. - anagrelide
anagrelide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- apomorphine
apomorphine and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- aripiprazole
aripiprazole and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
aripiprazole and deutetrabenazine both increase sedation. Use Caution/Monitor.
aripiprazole and deutetrabenazine both increase QTc interval. Use Caution/Monitor. - arsenic trioxide
arsenic trioxide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- artemether
artemether and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- asenapine
asenapine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
asenapine and deutetrabenazine both increase sedation. Use Caution/Monitor.
asenapine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - atomoxetine
atomoxetine and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- brexanolone
brexanolone, deutetrabenazine. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- buprenorphine transdermal
buprenorphine transdermal and deutetrabenazine both increase sedation. Use Caution/Monitor.
- bupropion
bupropion will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- butabarbital
butabarbital and deutetrabenazine both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and deutetrabenazine both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- carbamazepine
carbamazepine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- cariprazine
cariprazine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
cariprazine and deutetrabenazine both increase sedation. Use Caution/Monitor. - cenobamate
cenobamate, deutetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and deutetrabenazine both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and deutetrabenazine both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- chlorpropamide
chlorpropamide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- cinacalcet
cinacalcet will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- ciprofloxacin
deutetrabenazine and ciprofloxacin both increase QTc interval. Use Caution/Monitor.
- cisapride
deutetrabenazine and cisapride both increase QTc interval. Use Caution/Monitor.
- citalopram
citalopram and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- clemastine
clemastine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- clofazimine
clofazimine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- clomipramine
clomipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and clomipramine both increase QTc interval. Use Caution/Monitor. - clonazepam
clonazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and deutetrabenazine both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
clozapine and deutetrabenazine both increase sedation. Use Caution/Monitor. - codeine
codeine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dacomitinib
dacomitinib will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- darunavir
darunavir will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- dasatinib
dasatinib and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- desipramine
desipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and desipramine both increase QTc interval. Use Caution/Monitor. - dexchlorpheniramine
dexchlorpheniramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and deutetrabenazine both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- disopyramide
disopyramide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- dofetilide
dofetilide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- dolasetron
deutetrabenazine and dolasetron both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- doxepin
doxepin and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and doxepin both increase QTc interval. Use Caution/Monitor. - doxylamine
doxylamine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dronedarone
dronedarone and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- efavirenz
efavirenz and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- eliglustat
eliglustat and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- encorafenib
encorafenib and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- entrectinib
deutetrabenazine and entrectinib both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- escitalopram
escitalopram increases toxicity of deutetrabenazine by QTc interval. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, deutetrabenazine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- eslicarbazepine acetate
eslicarbazepine acetate and deutetrabenazine both increase sedation. Use Caution/Monitor.
- estazolam
estazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- eszopiclone
eszopiclone and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ethanol
ethanol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ethosuximide
ethosuximide and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ethotoin
ethotoin and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ezogabine
ezogabine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
- felbamate
felbamate and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fentanyl
fentanyl and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fentanyl intranasal
fentanyl intranasal and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fentanyl transdermal
fentanyl transdermal and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fentanyl transmucosal
fentanyl transmucosal and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fingolimod
fingolimod and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- fluconazole
deutetrabenazine and fluconazole both increase QTc interval. Use Caution/Monitor.
- fluoxetine
fluoxetine will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
deutetrabenazine and fluoxetine both increase QTc interval. Use Caution/Monitor. - fluphenazine
fluphenazine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
fluphenazine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and fluphenazine both increase QTc interval. Use Caution/Monitor. - flurazepam
flurazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fluvoxamine
deutetrabenazine and fluvoxamine both increase QTc interval. Use Caution/Monitor.
- fosphenytoin
fosphenytoin and deutetrabenazine both increase sedation. Use Caution/Monitor.
- fostemsavir
deutetrabenazine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gabapentin
gabapentin and deutetrabenazine both increase sedation. Use Caution/Monitor.
- gemifloxacin
deutetrabenazine and gemifloxacin both increase QTc interval. Use Caution/Monitor.
- gemtuzumab
deutetrabenazine and gemtuzumab both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- gilteritinib
deutetrabenazine and gilteritinib both increase QTc interval. Use Caution/Monitor.
- glasdegib
deutetrabenazine and glasdegib both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- granisetron
deutetrabenazine and granisetron both increase QTc interval. Use Caution/Monitor.
- haloperidol
haloperidol and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
haloperidol and deutetrabenazine both increase sedation. Use Caution/Monitor.
haloperidol and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - hydromorphone
hydromorphone and deutetrabenazine both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and hydroxyzine both increase QTc interval. Use Caution/Monitor. - ibutilide
ibutilide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- iloperidone
iloperidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
iloperidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
iloperidone and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - imipramine
imipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and imipramine both increase QTc interval. Use Caution/Monitor. - indacaterol, inhaled
deutetrabenazine and indacaterol, inhaled both increase QTc interval. Use Caution/Monitor.
- inotuzumab
inotuzumab and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- itraconazole
deutetrabenazine and itraconazole both increase QTc interval. Use Caution/Monitor.
- lacosamide
lacosamide and deutetrabenazine both increase sedation. Use Caution/Monitor.
- lamotrigine
lamotrigine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- lapatinib
deutetrabenazine and lapatinib both increase QTc interval. Use Caution/Monitor.
- lasmiditan
lasmiditan, deutetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, deutetrabenazine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
deutetrabenazine and levalbuterol both increase QTc interval. Use Caution/Monitor.
- levetiracetam
levetiracetam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- levofloxacin
deutetrabenazine and levofloxacin both increase QTc interval. Use Caution/Monitor.
- levorphanol
levorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- lithium
deutetrabenazine and lithium both increase QTc interval. Use Caution/Monitor.
- lofexidine
deutetrabenazine and lofexidine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- loperamide
deutetrabenazine and loperamide both increase QTc interval. Use Caution/Monitor.
- lopinavir
lopinavir will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
lopinavir and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - lorazepam
lorazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- loxapine
loxapine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
loxapine and deutetrabenazine both increase sedation. Use Caution/Monitor. - loxapine inhaled
loxapine inhaled and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
loxapine inhaled and deutetrabenazine both increase sedation. Use Caution/Monitor. - lumefantrine
lumefantrine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- lurasidone
lurasidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
lurasidone and deutetrabenazine both increase sedation. Use Caution/Monitor. - maprotiline
deutetrabenazine and maprotiline both increase QTc interval. Use Caution/Monitor.
- mefloquine
deutetrabenazine and mefloquine both increase QTc interval. Use Caution/Monitor.
- meperidine
meperidine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- methadone
methadone and deutetrabenazine both increase sedation. Use Caution/Monitor.
- methohexital
methohexital and deutetrabenazine both increase sedation. Use Caution/Monitor.
- methsuximide
methsuximide and deutetrabenazine both increase sedation. Use Caution/Monitor.
- metoclopramide
metoclopramide and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
- midazolam
midazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, deutetrabenazine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- mifepristone
mifepristone and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- mirabegron
mirabegron will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- mirtazapine
deutetrabenazine and mirtazapine both increase QTc interval. Use Caution/Monitor.
- morphine
morphine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- moxifloxacin
moxifloxacin and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- nalbuphine
nalbuphine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- nilotinib
nilotinib and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- nortriptyline
nortriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor. - octreotide
deutetrabenazine and octreotide both increase QTc interval. Use Caution/Monitor.
- ofloxacin
deutetrabenazine and ofloxacin both increase QTc interval. Use Caution/Monitor.
- olanzapine
olanzapine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
olanzapine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances - olodaterol inhaled
deutetrabenazine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor.
- osilodrostat
osilodrostat and deutetrabenazine both increase QTc interval. Use Caution/Monitor.
- oxaliplatin
oxaliplatin will increase the level or effect of deutetrabenazine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- oxazepam
oxazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- oxcarbazepine
oxcarbazepine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- oxycodone
oxycodone and deutetrabenazine both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ozanimod
ozanimod and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- paliperidone
paliperidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
paliperidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
paliperidone and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - paroxetine
paroxetine will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- pentazocine
pentazocine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and deutetrabenazine both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
perphenazine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and perphenazine both increase QTc interval. Use Caution/Monitor. - phenytoin
phenytoin and deutetrabenazine both increase sedation. Use Caution/Monitor.
- pimavanserin
pimavanserin and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
pimavanserin and deutetrabenazine both increase sedation. Use Caution/Monitor.
pimavanserin and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - pimozide
pimozide and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
pimozide and deutetrabenazine both increase sedation. Use Caution/Monitor.
pimozide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - pitolisant
deutetrabenazine and pitolisant both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- posaconazole
deutetrabenazine and posaconazole both increase QTc interval. Use Caution/Monitor.
- pregabalin
pregabalin and deutetrabenazine both increase sedation. Use Caution/Monitor.
- primaquine
deutetrabenazine and primaquine both increase QTc interval. Use Caution/Monitor.
- procainamide
procainamide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- prochlorperazine
prochlorperazine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
deutetrabenazine and prochlorperazine both decrease QTc interval. Use Caution/Monitor. - promethazine
promethazine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and promethazine both decrease QTc interval. Use Caution/Monitor. - protriptyline
protriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and protriptyline both increase QTc interval. Use Caution/Monitor. - quazepam
quazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- quetiapine
quetiapine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
quetiapine and deutetrabenazine both increase sedation. Use Caution/Monitor.
quetiapine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - quinidine
quinidine will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
quinidine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. Quinidine is a strong CYP2D6 inhibitor and also prolongs the QT interval. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors. - quinine
quinine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- ramelteon
ramelteon and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ranolazine
deutetrabenazine and ranolazine both increase QTc interval. Use Caution/Monitor.
- remifentanil
remifentanil and deutetrabenazine both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, deutetrabenazine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- rilpivirine
deutetrabenazine and rilpivirine both increase QTc interval. Use Caution/Monitor.
- risperidone
risperidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
risperidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and risperidone both increase QTc interval. Use Caution/Monitor. - ritonavir
ritonavir will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- rolapitant
rolapitant will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- romidepsin
deutetrabenazine and romidepsin both increase QTc interval. Use Caution/Monitor.
- rufinamide
rufinamide and deutetrabenazine both increase sedation. Use Caution/Monitor.
- salmeterol
deutetrabenazine and salmeterol both increase QTc interval. Use Caution/Monitor.
- secobarbital
secobarbital and deutetrabenazine both increase sedation. Use Caution/Monitor.
- selpercatinib
selpercatinib increases toxicity of deutetrabenazine by QTc interval. Use Caution/Monitor.
- sertraline
deutetrabenazine and sertraline both increase QTc interval. Use Caution/Monitor.
- solifenacin
deutetrabenazine and solifenacin both increase QTc interval. Use Caution/Monitor.
- sotalol
sotalol and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- sufentanil
sufentanil and deutetrabenazine both increase sedation. Use Caution/Monitor.
- sufentanil SL
sufentanil SL and deutetrabenazine both increase sedation. Use Caution/Monitor.
- sunitinib
deutetrabenazine and sunitinib both increase QTc interval. Use Caution/Monitor.
- suvorexant
suvorexant and deutetrabenazine both increase sedation. Use Caution/Monitor.
- tacrolimus
deutetrabenazine and tacrolimus both increase QTc interval. Use Caution/Monitor.
- tapentadol
tapentadol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- tasimelteon
tasimelteon and deutetrabenazine both increase sedation. Use Caution/Monitor.
- telavancin
deutetrabenazine and telavancin both increase QTc interval. Use Caution/Monitor.
- temazepam
temazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- terbinafine
terbinafine will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- thioridazine
thioridazine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
thioridazine and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
thioridazine will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors. - thiothixene
thiothixene and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
thiothixene and deutetrabenazine both increase sedation. Use Caution/Monitor. - tiagabine
tiagabine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- tipranavir
tipranavir will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.
- topiramate
topiramate and deutetrabenazine both increase sedation. Use Caution/Monitor.
- toremifene
toremifene and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- tramadol
tramadol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- triclabendazole
triclabendazole and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- trifluoperazine
trifluoperazine and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
trifluoperazine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and trifluoperazine both decrease QTc interval. Use Caution/Monitor. - trimipramine
trimipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and trimipramine both increase QTc interval. Use Caution/Monitor. - umeclidinium bromide/vilanterol inhaled
deutetrabenazine and umeclidinium bromide/vilanterol inhaled both decrease QTc interval. Use Caution/Monitor.
- valproic acid
valproic acid and deutetrabenazine both increase sedation. Use Caution/Monitor.
- vandetanib
vandetanib and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- vardenafil
deutetrabenazine and vardenafil both increase QTc interval. Use Caution/Monitor.
- vemurafenib
vemurafenib and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- venlafaxine
deutetrabenazine and venlafaxine both decrease QTc interval. Use Caution/Monitor.
- vigabatrin
vigabatrin and deutetrabenazine both increase sedation. Use Caution/Monitor.
- vilanterol/fluticasone furoate inhaled
deutetrabenazine and vilanterol/fluticasone furoate inhaled both increase QTc interval. Use Caution/Monitor.
- voclosporin
voclosporin, deutetrabenazine. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- voriconazole
deutetrabenazine and voriconazole both increase QTc interval. Use Caution/Monitor.
- vorinostat
deutetrabenazine and vorinostat both increase QTc interval. Use Caution/Monitor.
- zaleplon
zaleplon and deutetrabenazine both increase sedation. Use Caution/Monitor.
- ziprasidone
ziprasidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
ziprasidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
ziprasidone and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc. - zolpidem
zolpidem and deutetrabenazine both increase sedation. Use Caution/Monitor.
- zonisamide
zonisamide and deutetrabenazine both increase sedation. Use Caution/Monitor.
Minor (2)
- azithromycin
azithromycin increases toxicity of deutetrabenazine by QTc interval. Minor/Significance Unknown.
- chloroquine
chloroquine increases toxicity of deutetrabenazine by QTc interval. Minor/Significance Unknown.
Adverse Effects
>10%
Somnolence (11%)
1-10%
Diarrhea (9%)
Dry mouth (9%)
Fatigue (9%)
Urinary tract infection (7%)
Insomnia (7%)
Anxiety (4%)
Constipation (4%)
Contusion (4%)
Dizziness (4%)
Akathisia, agitation, or restlessness (4%)
Depression in patients with Huntington’s disease (4%)
Suicidal ideation in patients with Huntington’s disease (2%)
Parkinsonism in patients with Huntington’s disease
Warnings
Black Box Warnings
Can increase risk for depression and suicidality in patients with Huntington disease; when prescribing, consider this risk with the clinical need for chorea treatment
Closely monitor for emergence or worsening of depression, suicidality, or unusual changes in behavior
Inform patients, caregivers, and families of the risk of depression and suicidality; instruct them to report behaviors of concern promptly to the treating physician
Particular caution is needed with a history of depression or prior suicide attempts or ideation, which are increased in frequency in Huntington disease
Deutetrabenazine is contraindicated in patients who are suicidal, and in patients with untreated or inadequately treated depression
Contraindications
Patients with Huntington disease who are suicidal, or in patients with untreated or inadequately treated depression
Hepatic impairment
Coadministration with MAOIs; deutetrabenazine should not be used in combination with an MAOI or within 14 days of discontinuing an MAOI
Coadministration with reserpine; at least 20 days should elapse after stopping reserpine before initiating deutetrabenazine
Coadministration with tetrabenazine or valbenazine
Cautions
Huntington disease is a progressive disorder characterized by changes in mood, cognition, chorea, rigidity, and functional capacity over time; VMAT2 inhibitors, including deutetrabenazine, may cause a worsening in mood, cognition, rigidity, and functional capacity; periodically reevaluate the need for deutetrabenazine by assessing effect on chorea and adverse effects
Patients with Huntington disease are at increased risk for depression and suicidality; deutetrabenazine may increase this risk (see Black Box Warnings and Contraindications)
May increase the risk of akathisia, agitation, and restlessness in patients with Huntington’s disease and tardive dyskinesia; reduce dose or discontinue if this occurs
Sedation/somnolence reported; may impair patient’s ability to drive or operate complex machinery
Drug may prolong QT interval, but the degree of QT prolongation is not clinically significant when drug is administered within recommended dosage range
Tetrabenazine, a closely related VMAT2 inhibitor, causes an increase (about 8 msec) in the corrected QT (QTc) interval; avoid in patients with congenital long QT syndrome or history of cardiac arrhythmias; for deutetrabenazine doses >24 mg/day in patients who are using other drugs known to prolong QTc, assess the QTc interval before and after increasing the deutetrabenazine dose or other medications that are known to prolong QTc
Elevated serum prolactin levels may occur; tissue culture experiments indicate that approximately one third of human breast cancers are prolactin-dependent in vitro, a factor of potential importance if deutetrabenazine is being considered for a patient with previously detected breast cancer; if there is clinical suspicion of symptomatic hyperprolactinemia, appropriate laboratory testing, and discontinuation of therapy should be considered
Deutetrabenazine and its metabolites bind to melanin-containing tissues and can accumulate in these tissues over time; ophthalmologic monitoring in humans was inadequate in clinical trials to exclude the possibility of injury after long-term exposure
Neuroleptic malignant syndrome (NMS)
- Reported with drugs that reduce dopaminergic transmission; while not observed with deutetrabenazine, it has been reported with tetrabenazine
- Monitor for manifestations of NMS (eg, hyperpyrexia, muscle rigidity, altered mental status, autonomic instability, increased creatinine phosphokinase, myoglobinuria, rhabdomyolysis, acute renal failure)
- Manage NMS by immediately discontinuing the drug and intensively treating symptoms and any concomitant serious medical problems; there is no general agreement about specific pharmacological treatment regimens for NMS
- Recurrence of NMS has been reported with resumption of drug therapy; if treatment with drug needed after recovery from NMS, patients should be monitored for signs of recurrence;
Parkinsonism
- May cause parkinsonism in patients with Huntington’s disease or tardive dyskinesia
- Parkinsonism has been observed with other VMAT2 inhibitors
- Difficult to distinguish between potential drug-induced parkinsonism and progression of underlying Huntington’s disease
- Parkinsonism in patients treated with drug for tardive dyskinesia reported; symptoms have included bradykinesia, gait disturbances
- In most cases, parkinsonism occurred within first two weeks after starting or increasing dose
- Parkinsonism was reported to resolve following discontinuation of therapy
- If parkinsonism develops during treatment, dose should be reduced; some patients may require discontinuation of therapy
Drug interaction overview
- Coadministration with dopamine antagonists or antipsychotics may increase risk for parkinsonism, NMS, and akathisia
- Coadministration with alcohol and other sedating drugs may worsen somnolence associated with deutetrabenazine
-
Strong CYP2D6 inhibitors
- Deutetrabenazine is extensively biotransformed to its major active dihydro-metabolites, alpha and beta-HTBZ, which are subsequently metabolized primarily by CYP2D6
- Dose reduction of deutetrabenazine may be necessary when adding a strong CYP2D6 inhibitor in patients maintained on a stable dose
- Systemic exposure of the active dihydro-metabolites is increased ~3-fold when coadministered with strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine, bupropion)
- Do not exceed 36 mg/day or a single dose of 18 mg if coadministered with a strong CYP2D6 inhibitor
-
QTc prolongation
- Clinically relevant QT prolongation may occur in some patients treated with deutetrabenazine who are CYP2D6 poor metabolizers or are coadministered a strong CYP2D6 inhibitor; see above information (strong CYP2D6 inhibitors) for dose modifications/limitations
- For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc
- Assess other risks for QT prolongation; certain circumstances may increase the risk of the occurrence of torsade de pointes and/or sudden death in association with the use of drugs that prolong the QTc interval, including bradycardia, hypokalemia, or hypomagnesemia; concomitant use of other drugs that prolong the QTc interval; and presence of congenital prolongation of the QT interval
-
Contraindicated drug combinations
- Coadministration with MAOIs is contraindicated; deutetrabenazine should not be used in combination with an MAOI or within 14 days of discontinuing an MAOI
- Coadministration with reserpine is contraindicated; at least 20 days should elapse after stopping reserpine before initiating deutetrabenazine; reserpine binds irreversibly to VMAT2 and the duration of its effects is several days; wait for chorea to reemerge before administering deutetrabenazine to reduce risk of overdosage and major depletion of serotonin and norepinephrine in the CNS
- Coadministration with tetrabenazine is contraindicated (see Dosing information on how to switch from tetrabenazine)
Pregnancy & Lactation
Pregnancy
There are no adequate data on the developmental risk in pregnant women
Animal studies
- Administration of deutetrabenazine to rats during organogenesis produced no clear adverse effect on embryofetal development
- However, administration of tetrabenazine to rats throughout pregnancy and lactation resulted in an increase in stillbirths and postnatal offspring mortality
Lactation
Unknown if distributed in human breast milk
Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Oral vesicular monoamine transporter-2 (VMAT-2) inhibitor; decreases uptake of monoamines (eg, dopamine, serotonin, norepinephrine, histamine) into synaptic vesicles and depletes monoamine stores from nerve terminals
The precise mechanism by which deutetrabenazine exerts its antichorea effects is unknown, but is believed to be related to its effect on reversible depletion of monoamines from nerve terminals
Absorption
Bioavailability: 80%
Plasma concentrations of deutetrabenazine are generally below the limit of detection because of the extensive hepatic metabolism
Peak plasma time (active metabolites): 3-4 hr
Distribution
Vd: 500 L (alpha-HTBZ); 730 L (beta-HTBZ)
Binds to melanin-containing tissues (eg, skin, eyes)
Following IV administration of tetrabenazine: Rapidly distributed to the brain, with the highest binding in the striatum and the lowest in the cortex
Protein bound
- Tetrabenazine: 82-85%
- Alpha-HTBZ: 60-68%
- Beta-HTBZ: 59-63%
Metabolism
Deutetrabenazine is extensively biotransformed, mainly by carbonyl reductase, to its major active metabolites alpha-HTBZ and betaHTBZ, which are subsequently metabolized primarily by CYP2D6, with minor contributions of CYP1A2 and CYP3A4/5, to form several minor metabolites
Elimination
Half-life (active metabolites): 9-10 hr
Clearance: 47 L/hr (alpha-HTBZ); 70 L/hr (beta-HTBZ)
Excretion: 75-86% urine; 8-11% feces
Pharmacogenomics
CYP2D6 poor metabolizers
- Although the pharmacokinetics of deutetrabenazine and its metabolites have not been systematically evaluated in patients who do not express the drug metabolizing enzyme, it is likely that the exposure to alpha and beta-HTBZ would be increased similarly to taking a strong CYP2D6 inhibitor (~3-fold)
- Decrease deutetrabenazine dose if administered in CYP2D6 poor metabolizers
- Also see Cautions and Dosage Modification
Administration
Oral Administration
Administer with food
Swallow tablet whole; do not chew, crush, or break
Discontinuing treatment: Can be discontinued without tapering
Switching from tetrabenazine to deutetrabenazine
- Discontinue tetrabenazine and initiate deutetrabenazine the following day
Recommended initial deutetrabenazine dose when switched from tetrabenazine
- Tetrabenazine 12.5 mg/day: Initiate with deutetrabenazine 6 mg/day
- Tetrabenazine 25 mg/day: Initiate with deutetrabenazine 6 mg/day
- Tetrabenazine 37.5 mg/day: Initiate with deutetrabenazine 9 mg/day
- Tetrabenazine 50 mg/day: Initiate with deutetrabenazine 12 mg/day
- Tetrabenazine 62.5 mg/day: Initiate with deutetrabenazine 15 mg/day
- Tetrabenazine 75 mg/day: Initiate with deutetrabenazine 18 mg/day
- Tetrabenazine 87.5 mg/day: Initiate with deutetrabenazine 21 mg/day
- Tetrabenazine 100 mg/day: Initiate with deutetrabenazine 24 mg/day
Treatment interruption
- ≥1 week: Must titrate dose when resumed (as with initial treatment)
- <1 week: May resume at previous maintenance dose without titration
Storage
Store at 25C (77F); excursions permitted to 15-30C (59-86F)
Protect from light and moisture
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Austedo oral - | 9 mg tablet |  | |
| Austedo oral - | 12 mg tablet |  | |
| Austedo oral - | 6 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Formulary
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