Valbenazine (US Brand name Ingrezza®) is a vesicular monoamine transporter 2 (VMAT2) inhibitor. Here is basic information about this medication. Other articles on this website with more advanced information and tips related to this medication are linked to under Related Pages below.
FDA-approved indications
Treatment of adults with tardive dyskinesia
Dosage
The initial dose is 40 mg once a day.
After one week, the dose should usually be increased to 80 mg once daily.
But, there are some exceptions.
If the person cannot tolerate 80 mg/day, the dose can be reduced to either 60 mg/day or 40 mg/day. Note: Valbenazine is available not only in 40 mg and 80 mg capsules but now also in 60 mg strength.
Also, the maximum recommended dose is 40 mg once daily in the following persons:
1. Those who are CYP2D6 poor metabolizers.
2. Those who are also taking a medication that is a strong CYP2D6 inhibitor. This is not a farfetched scenario; the use of such medications is not rare. Examples of medications that are strong 2D6 inhibitors include (alphabetically):
– Bupropion
– Cinacalcet (used to reduce serum calcium, for example, in patients with chronic renal disease who are on dialysis)
– Fluoxetine
– Paroxetine
– Quinidine.
3. Those who are also taking a medication that is a strong CYP3A4 inhibitor. Examples of medications that are strong 3A4 inhibitors are (alphabetically) clarithromycin, itraconazole, ketoconazole.
4. Those with moderate or severe impairment of liver function.
Administration and instructions
Valbenazine can be taken with or without food.
Dosage forms and strengths
Capsules: 40 mg, 60 mg, 80 mg
Warnings
Valbenazine carries a warning about somnolence and about the risk of QT prolongation.
Potential side effects
Please see THIS PAGE for a handout listing both the common and less common side effects of this medication along with the percentages of patients who report them.
Pharmacokinetics
Valbenazine is metabolized by two pathways:
1. By hydrolysis to its active metabolite [+]-α-HTBZ. This active metabolite is then metabolized by CYP450 2D6
2. By oxidative metabolism (mainly by CYP450 3A4/5).
This is why dose reduction is recommended in both:
– Those who are CYP450 2D6 poor metabolizers or taking a strong 2D6 inhibitor
– Those taking a strong 3A4 inhibitor.
Important! Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Related Pages
Potential side effects of valbenazine (Ingrezza®) handout
How well does valbenazine (Ingrezza®) work for tardive dyskinesia?
What is VMAT2 and what do VMAT2 inhibitors do?
Comparing the VMAT2 inhibitors
Deutetrabenazine (Austedo®): Basic Information
Deutetrabenazine (Austedo®) for tardive dyskinesia
Management of tardive dyskinesia: First-line options
Management of tardive dyskinesia: Second-line options
Is TD less likely with second-generation (“atypical”) antipsychotics?
Antidepressant-induced tardive dyskinesia
Abnormal Involuntary Movement Scale (AIMS)
Abnormal Involuntary Movement Scale (AIMS): Examination procedure
Abnormal Involuntary Movement Scale (AIMS): Scoring instructions
Side effects: Main Menu
References
Prescribing Information for valbenazine (Ingrezza®)
Copyright © 2018 to 2026, Simple and Practical Medical Education, LLC. All rights reserved. The content on this website may not be reproduced in any form without express written permission.
Disclaimer: The material on this website is provided as general education for medical professionals. It is not intended for patients or other laypersons, nor is it a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified healthcare professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most up-to-date information.