How can one manage Tardive Dyskinesia (TD)? Are there treatments for TD or other tardive movement disorders?

Tardive dyskinesia (TD) is a movement disorder that starts after the use of a dopamine receptor blocking medication for at least a few months. These medications include most antipsychotic medications and metoclopramide. When a patient develops TD, the first intervention is to taper and discontinue the offending medication. This should be done with close monitoring, since it can worsen symptoms of psychosis or depression. If a patient continues to require antipsychotic medication, the medication used should be a second generation antipsychotic at the lowest effective dosage. There is little evidence to support any particular second-generation medication, with the exception of quetiapine and clozapine. Quetiapine has a low level of dopamine blockade, and sometimes allows TD to improve. Clozapine has no liability for movement disorders or TD, and sometimes allows TD to improve. Every antipsychotic medication can cause side effects, and this guides the treatment plan. At this point, the need for further treatment of TD should be assessed; symptoms can sometimes be mild and not result in disability or be bothersome. If the TD is clinically significant, pharmacologic treatment should be considered. Treatment guidelines recommend that patients who have moderate to severe or disabling tardive dyskinesia be treated with a reversible inhibitor of the vesicular monoamine transporter-2 (VMAT2). Three VMAT2 inhibitors are available in the U.S.: deutetrabenazine, valbenazine and tetrabenazine. Deutetrabenazine and valbenazine have been found safe and effective in clinical trials and are approved by the FDA for the treatment of TD.

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