Treatment of Troublesome Tardive Dyskinesia Interfering with Activities of Daily Living in Patients on Antipsychotics

Tardive dyskinesia can develop in patients receiving antipsychotic therapy for an approved indication. When the involuntary movements reach at least moderate severity and begin to disrupt daily functioning and quality of life, active treatment is warranted.

Clinical Scenario

The patient is maintained on an antipsychotic for an approved psychiatric indication. Tardive dyskinesia is present, rated at least moderate in severity, and is troublesome — meaningfully interfering with activities of daily living and quality of life.

Approach to Treatment

When disability from tardive dyskinesia is at least moderate and affects daily life, suppressive therapy is indicated. First-line treatment involves new-generation VMAT2 inhibitors. The complete protocol covers drug selection, the conditions under which alternatives apply, and the sequencing of further options.

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References

DOI: 10.1016/j.jns.2018.02.010

In patients with troublesome TS, suppressive agents should be considered.
Suppressive therapy should be considered when disabilities are at least moderate and interfere with ADLs and QoL, with new VMAT2 inhibitors or TBZ (if both Deut-TBZ and valbenazine are not available) as the first-line treatment, with clonazepam and Ginkgo biloba as second-line, and combined with amantadine if symptoms are still troublesome.
New generation VMAT2 inhibitors, either Deut-TBZ or valbenazine, should be considered as first-line therapy.

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