VMAT2 Inhibitors for Tardive Dyskinesia: What Psychiatrists Should Know

Tardive dyskinesia (TD) is characterized by involuntary movements that develop in association with chronic use of antipsychotic medications. While second-generation antipsychotics are associated with lower risk of TD compared with first-generation antipsychotics, their widespread use across a range of chronic mental health conditions (such as psychotic disorders, autism, and mood disorders) has resulted in substantial public health burden of TD. The therapeutic landscape of managing TD has been transformed by the U.S. Food and Drug Administration (FDA) approval of two selective vesicular monoamine transporter 2 (VMAT2) inhibitors in 2017. This report reviews efficacy and safety considerations for the two FDA-approved VMAT2 inhibitors, deutetrabenazine and valbenazine, which are recommended as first-line treatment for troublesome TD in current practice guidelines. Overall, these VMAT2 inhibitors offer significant benefit to patients experiencing TD through improved health and quality of life.