Austedo vs. Xenazine: 7 Similarities and Differences Between These Huntington’s Chorea Medications
Key takeaways:
Austedo (deutetrabenazine) and Xenazine (tetrabenazine) are prescription medications that treat movement problems (chorea) from Huntington’s disease. Austedo can also treat tardive dyskinesia.
Both medications are effective treatments for their intended purpose. But Austedo can be taken less frequently and may come with fewer brain-related side effects.
Austedo and Xenazine are both available as brand-name medications. But you can also find Xenazine as a lower-cost generic. GoodRx can help make your prescription more affordable.
Access savings on related medications
Table of contents
Uncontrollable body movements don’t affect everyone. But they’re problematic and possible for certain people, including those living with Huntington’s disease.
A common symptom of this genetic brain condition is chorea — sudden and involuntary bodily movements that can worsen with time. This change primarily affects your limbs, face, and/or torso.
At this time, there isn’t a cure for Huntington’s disease. But some medications, like Austedo (deutetrabenazine) and Xenazine (tetrabenazine), can help reduce the mobility issues it causes. Here, we’ll highlight seven ways that Austedo and Xenazine stack up.
1. They have similar active ingredients
Tetrabenazine and deutetrabenazine are the active ingredients in Xenazine and Austedo, respectively. They’re both vesicular monoamine transporter type 2 (VMAT2) inhibitors.
People with movement disorders like Huntington’s disease often have too much dopamine (and other related chemicals) in their brain. VMAT2 inhibitors can reduce these chemicals by blocking a protein in nerve cells called VMAT2. This is thought to calm jerky, unpredictable body movements.
The main difference between these medications is how long each dose lasts. Austedo lasts longer than Xenazine because it has atoms that help with stability (deuterium). This is where the “deu” prefix in its generic name comes from.
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2. Austedo has one more approved use than Xenazine
Xenazine and its generic equivalents are FDA-approved to treat chorea from Huntington's disease in adults. Xenazine was the first VMAT2 inhibitor to obtain FDA approval. And it’s only available with a prescription from your healthcare provider.
Austedo has two approved uses in adults. It’s a brand-name-only, prescription medication that treats chorea from Huntington’s disease and tardive dyskinesia (TD). TD is a movement disorder caused by medications that affect dopamine levels in the brain. Xenazine isn’t approved for TD.
3. Austedo and Xenazine have different dosages
Xenazine is taken 2 to 3 times daily, while Austedo is taken 1 or 2 times daily. But these dosages have some layers.
People new to Xenazine usually start off by taking one 12.5 mg tablet daily. After about a week, it’s common to move up to 12.5 mg twice daily. From there, your doses are personalized based on your response to the medication. If you end up needing 37.5 mg per day or more, you’ll likely be told to split it up into three smaller doses throughout the day.
On the other hand, two versions of Austedo are available: Austedo IR (the original formulation) and Austedo XR (an extended-release formulation). Austedo comes as 6 mg, 9 mg, and 12 mg tablets. Austedo XR comes as 6 mg, 12 mg, and 24 mg tablets.
Austedo dosages are a bit more simple than Xenazine dosages:
Austedo: You’ll likely start off by taking one 6 mg tablet twice daily. Every week, you have the option to increase your total daily dose by 6 mg until your symptoms are under control. The average dose for many people is 36 mg daily, but you shouldn’t ever exceed 48 mg in a given day.
Austedo XR: You’ll start off by taking a 12 mg tablet once daily. But the other steps are the same as above.
Be mindful of food while you’re taking Austedo
If you’re prescribed Austedo, it’s a good idea to take each dose with a snack or meal. Taking it with food can increase medication levels in the body, giving it a better chance for success.
This is not the case for Xenazine or Austedo XR. You can take them with or without food.
Switching from Xenazine to Austedo
Austedo has some potential benefits over Xenazine. Because of this, some people with chorea symptoms may decide to switch from Xenazine to Austedo.
If your healthcare provider wants you to do this, they’ll likely follow a specific process. This is based on your current Xenazine dose. For example:
Xenazine 12.5 mg twice daily: Switch to Austedo 6 mg twice daily or Austedo XR 12 mg once daily.
Xenazine 25 mg twice daily: Switch to Austedo 12 mg twice daily or Austedo XR 24 mg once daily.
Xenazine 37.5 mg twice daily: Switch to Austedo 18 mg twice daily or Austedo XR 36 mg once daily.
If you do switch, your healthcare provider will likely recommend taking your first Austedo dose the day after your last Xenazine dose. But don’t ever make this medication switch without talking to them first.
4. Austedo generally has less side effects
Austedo and Xenazine both reduce chorea symptoms from Huntington’s disease. But Austedo may come with less side effects and be easier to tolerate over time.
In clinical studies, Austedo had significantly less brain-related side effects than Xenazine. This includes a lower risk of:
Depression
Feeling agitated
Difficulty sleeping
Drowsiness or fatigue
Tremors
Trouble sitting still
However, both medications have a boxed warning, the FDA’s most serious warning, about an increased risk of depression and thoughts of suicide. If you or a loved one develop new or worsening symptoms of depression and/or self harm after starting either medication, contact your provider right away.
Make sure to ask your healthcare provider and pharmacist about other Austedo side effects or Xenazine side effects you can expect.
5. Interactions can be an issue
Austedo and Xenazine are similar in design, so they have similar drug interactions. The biggest interactions are with medications that block a specific enzyme in your body called “CYP2D6.” This liver enzyme is in charge of breaking down Austedo and Xenazine. If it can’t work properly, drug levels can build up and lead to extra side effects.
To manage this risk, you shouldn’t take more than 36 mg of Austedo or 50 mg of Xenazine daily if you’re also taking any of these medications:
Fluoxetine (Prozac)
Paroxetine (Paxil)
Bupropion (Wellbutrin SR, Wellbutrin XL)
Quinidine
Dacomitinib (Vizimpro)
Tipranavir (Aptivus)
Other Austedo and Xenazine interactions to look out for include:
Antipsychotics such as olanzapine (Zyprexa)
Dopamine antagonists such as metoclopramide (Reglan)
Monoamine oxidase inhibitors such as selegiline (Zelapar, Emsam)
Reserpine
Sedative medications like benzodiazepines
Alcohol
Keep in mind: This isn’t an all-encompassing list. Make sure your pharmacist has an updated list of medications you take. This will help them screen for other possible interactions.
6. Austedo and Xenazine are different from Ingrezza
Austedo and Xenazine aren’t the only VMAT2 inhibitors. Ingrezza (valbenazine) is another option.
A couple things make Ingrezza unique. It comes as a once daily, prescription-only capsule instead of a tablet. And it’s only approved to treat TD in adults — not chorea from Huntington’s disease. Many experts view Austedo and Ingrezza as comparable treatment options for TD.
7. There are ways to save on both Austedo and Xenazine
There are many ways to save on Austedo and Xenazine. Both are available as brand-name medications. But you can also find Xenazine as a lower-cost generic. GoodRx can help you navigate ways to save on your prescription.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Austedo’s or Xenazine’s patient assistance programs, which offer the medication free of charge.
Save with a free trial voucher. If you’re new to Austedo, you may be able to redeem a voucher for 30 days of free medication.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Austedo’s price is as little as $0 using a savings card from the manufacturer. Xenazine’s price is as little as $10 using a manufacturer savings card.
The bottom line
Austedo and Xenazine are medications that treat movement problems (chorea) from Huntington’s disease. Austedo can also treat tardive dyskinesia. While side effects and drug interactions are possible with each medication, Austedo is generally better tolerated and taken less often throughout the day.
Why trust our experts?
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
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