Ingrezza
Ingrezza (valbenazine) is a VMAT2 inhibitor that's used to treat tardive dyskinesia (TD) in adults. It can also treat chorea (random muscle movements) in adults with Huntington's disease. Ingrezza (valbenazine) is a capsule that's convenient to take because the dosing is typically once per day by mouth. But this medication can have side effects, like sleepiness, fatigue, and other movement problems (e.g., parkinsonism).
What is Ingrezza (valbenazine)?
What is Ingrezza (valbenazine) used for?
- Tardive dyskinesia (TD) in adults
- Chorea (random muscle movements) in adults with Huntington's disease
How Ingrezza (valbenazine) works
Ingrezza (valbenazine) is a vesicular monoamine transporter 2 (VMAT2) inhibitor. It's not exactly known how the medication helps with movement problems, but it's thought to block the VMAT2 protein in your brain. This lowers the amount of certain chemicals, like dopamine and serotonin, that are released in the brain and are involved with movements of your body.
Drug facts
Side effects of Ingrezza (valbenazine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Tardive dyskinesia:
- Sleepiness (11%)
- Dry mouth (5%)
- Constipation (5%)
- Blurry vision (5%)
- Trouble urinating (5%)
Chorea from Huntington's disease:
- Sleepiness (19%)
- Fatigue (14%)
- Hives or rash (up to 9%)
- Not able to stay still (6%)
- Trouble sleeping (6%)
- Diarrhea (5%)
- Nausea (5%)
- Depression (5%)
- Back pain (5%)
Less Common Side Effects
- Balance problems or falls
- Restlessness
- Joint pain
- Weight gain
Ingrezza (valbenazine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts and behaviors
- Abnormal heart rhythm (QT prolongation): chest pounding, short of breath, chest pain, feeling faint, lightheaded
- Neuroleptic malignant syndrome: high fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Movement abnormalities (parkinsonism): tremor, slow movement, impaired speech, muscle stiffness, losing balance easily
- Serious allergic reaction: hives; rash; swelling of the face, tongue, or around the eyes; trouble breathing; wheezing; trouble swallowing
The following Ingrezza (valbenazine) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
- Muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, shuffling walk
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Ingrezza (valbenazine)
Pros
- Works well for treating TD and chorea from Huntington's disease
- Taken once per day, with or without food
- No need to be weaned off slowly if you're stopping the medication
Cons
- Lots of drug interactions, including some common antidepressants
- Can take about 2 weeks to start working and a few months to get the most from the medication
- Not known if safe during pregnancy or while breastfeeding
Pharmacist tips for Ingrezza (valbenazine)
- You can take Ingrezza (valbenazine) by mouth with or without food. Try taking the medication with food if it upsets your stomach.
- Ingrezza (valbenazine) can cause sleepiness and blurry vision. Don't drive or operate machinery until you know how this medication affects you.
- Avoid alcohol while you're taking Ingrezza (valbenazine). Alcohol can make you feel more intense side effects from the medication, such as sleepiness.
- Tell your prescriber and pharmacist about all the medications, vitamins, and supplements you're taking or planning to take. There are many medications that interact with Ingrezza (valbenazine), so your healthcare team can check that all your medications are safe to take together. Some medications might need dose adjustments, while others might need to be switched to something else altogether.
- Talk to your prescriber to see whether Ingrezza (valbenazine) is right for you if you're pregnant or thinking of getting pregnant. There haven't been enough studies looking at how Ingrezza (valbenazine) affects mothers and unborn babies when it's taken during pregnancy. But animal studies show that it's possible for the medication to cause harm to unborn babies.
- Avoid breastfeeding while you're taking Ingrezza (valbenazine). It's not known whether the medication can pass into your breast milk and harm your baby, but some animal studies show that it's possible. Wait 5 days after your last Ingrezza (valbenazine) dose before you start breastfeeding if you wish to nurse your infant.
More tips for Ingrezza Sprinkle (valbenazine) capsules:
- You can swallow Ingrezza Sprinkle capsules whole with water.
- You can also open the Ingrezza Sprinkle capsule and place the granules into a bowl with about 1 tablespoon of soft food (e.g., applesauce, yogurt, pudding). Don't mix with milk or drinking water. Stir the medication well into the soft food. Then, swallow the mixture right away and drink a glass of water afterwards.
- If needed, you can keep the Ingrezza Sprinkle-soft food mixture at room temperature for up to 2 hours. But throw it away if you haven't taken the mixture yet or if you have leftover medication 2 hours after you've prepared it.
- Don't crush or chew the Ingrezza Sprinkle capsules.
- Don't place the Ingrezza Sprinkle capsule, granules, or prepared mixture through any feeding tubes. The medication can block the tube.
Common questions about Ingrezza (valbenazine)
No, Ingrezza (valbenazine) isn't a controlled substance. This medication doesn't have a risk of misuse or dependence.
No, Ingrezza (valbenazine) doesn't cause tardive dyskinesia (TD), which is when you have uncontrollable muscle movements. Instead, it actually helps treat TD. But this medication can cause other movement problems called parkinsonism as a side effect. Parkinsonism are abnormal movements, such as a tremor, slow movement, impaired speech, muscle stiffness, and loss of balance. Talk to your prescriber if you have any unusual movements after you start Ingrezza (valbenazine).
Studies show that people taking Ingrezza (valbenazine) for TD or chorea from Huntington's disease started to see improvement in symptoms in as little as 2 weeks. But it can take up to 6 weeks for some people with TD and up to 12 weeks for some people with chorea from Huntington's disease to get the maximum benefit from Ingrezza (valbenazine). Keep in mind that everyone can respond differently to the medication. Talk to your prescriber if you're concerned with how well Ingrezza (valbenazine) is working for you.
It's not clear whether the Ingrezza (valbenazine) capsules can be opened or not. But you can open the Ingrezza Sprinkle (valbenazine) capsules. Pour all the granules inside the Ingrezza Sprinkle capsule in a bowl with about 1 tablespoon of soft food (for example, applesauce, yogurt, or pudding); don't mix with milk or drinking water. Stir the medication into the soft food with a spoon. Once stirred well, swallow the mixture right away and drink a glass of water afterwards. Ask your prescriber about switching to the Ingrezza Sprinkle capsules if you're having trouble swallowing capsules whole.
Weight gain is a possible side effect of Ingrezza (valbenazine), but it's not common. Only up to 1% of people who took Ingrezza (valbenazine) reported weight gain in clinical studies. To lower your risk for weight gain while you're taking this medication, make sure to eat a balanced and nutritious diet and regularly exercise. Contact your prescriber or primary care provider if you notice significant changes in weight while you're taking Ingrezza (valbenazine).
It takes about 3 to 4.5 days for most of Ingrezza (valbenazine) to leave your body after a single dose. This time frame is estimated based on the half-life of Ingrezza (valbenazine). Keep in mind that how long the medication stays in your system can depend on your genetics, among some other factors.
Yes, Ingrezza (valbenazine) is a specialty medication. This means that the medication isn't typically available at your local pharmacy, but through a specialty pharmacy. You'll usually have the option of having your medication mailed directly to you. Talk to your prescriber if you have questions on how to get Ingrezza (valbenazine).
No, Ingrezza (valbenazine) isn't an antipsychotic and it doesn't help treat mental health problems, like bipolar disorder or schizophrenia. Ingrezza (valbenazine) is a medication that can help treat a possible side effect of antipsychotics called tardive dyskinesia (TD). Ask your prescriber whether Ingrezza (valbenazine) is right for you if you start having TD from any antipsychotics that you might be taking.
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Risks and warnings for Ingrezza (valbenazine)
Ingrezza (valbenazine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Depression and suicidal thoughts and behavior
- Risk factors: Huntington's disease | History of mental health problems
Ingrezza (valbenazine) can raise the risk of depression and thoughts of suicide or harming yourself, especially in people with Huntington's disease. Your prescriber might screen you for depression and suicidal thoughts throughout your treatment. Call a healthcare professional right away if you or a loved one notices that you have signs of depression, suicidal thoughts, or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated) while you're taking Ingrezza (valbenazine).
Allergic reactions
Serious allergic reactions to Ingrezza (valbenazine) are possible, including life-threatening reactions like swelling of the throat. Get medical attention right away if you notice dizziness; nausea; a choking sensation; trouble breathing; swelling of the lips, tongue, around the eyes, or face after you take Ingrezza (valbenazine).
Sleepiness
- Risk factors: Drinking alcohol while taking Ingrezza (valbenazine) | Taking other medications that cause sleepiness
Ingrezza (valbenazine) can make you sleepy, which can affect your ability to focus, think, or react. This side effect is more likely to happen or be more intense if you drink alcohol while you're taking Ingrezza (valbenazine) or if you take other medications that cause sleepiness (e.g., opioids, benzodiazepines). Don't drive or operate machinery until you know how Ingrezza (valbenazine) affects you.
Life-threatening abnormal heart rhythm (QT prolongation)
- Risk factors: Taking other medications that cause QT prolongation | Born with QT prolongation | History of abnormal heart rhythms (arrhythmias)| Taking medications that interact with Ingrezza (valbenazine)
Although rare, Ingrezza (valbenazine) might lengthen the time period from when the heart squeezes and then relaxes. This is known as QT prolongation. When this happens, it raises the risk for life-threatening abnormal heart rhythms. Your risk of QT prolongation is greater if you take Ingrezza (valbenazine) with other medication(s) that cause QT prolongation or medications that interact with Ingrezza (valbenazine).
Make sure to tell your prescriber about your medical history. People who were born with QT prolongation or have a history of arrhythmias should avoid taking Ingrezza (valbenazine). Also be sure to tell your healthcare team about all the medications you're taking. Don't start any new medications while you're taking Ingrezza (valbenazine) without talking to your prescriber or pharmacist first.
Your prescriber might order tests to check your heart if you're at risk for QT prolongation. Call 911 right away if you feel your chest pounding, short of breath, chest pain, feeling faint, or lightheaded while you're taking Ingrezza (valbenazine).
Neuroleptic malignant syndrome
- Risk factors: Taking antipsychotic medications or other medications that lower dopamine levels
Taking Ingrezza (valbenazine) can potentially lead to a rare, but life-threatening condition called neuroleptic malignant syndrome (NMS). Symptoms include high fever, sweating, stiff muscles, confusion, not being aware of your surroundings, and fast or irregular heartbeat. Your risk is higher if you take other medications that can cause NMS, such as antipsychotics (e.g., haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa)). Get medical attention as soon as possible if you have any symptoms of NMS while you're taking Ingrezza (valbenazine). You'll probably have to stop taking Ingrezza (valbenazine) and switch to another medication.
Movement abnormalities (parkinsonism)
Ingrezza (valbenazine) might cause parkinsonism, or abnormal movements such as a tremor, slow movement, impaired speech, muscle stiffness, and loss of balance. These abnormal movements can lead to falls. In most reported cases, any severe parkinsonism happened within the first two weeks after starting or raising the dose of Ingrezza (valbenazine). This problem typically went away after lowering the dose or stopping the medication. Tell your healthcare team if you experience any of these abnormal movements while you're taking Ingrezza (valbenazine). You'll probably have to stop taking the medication if your abnormal movements still don't get better.
Ingrezza (valbenazine) dosage
Dose pack| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 28 tablets of 40mg and 80mg | 1 dose pack | $8,461.94 | $8,461.94 |
Typical dosage for Ingrezza (valbenazine)
The typical starting dose is 40 mg by mouth once per day. Depending on how you tolerate and respond to the medication, the dose will slowly be raised up to the recommended dose of 80 mg once per day.
Your dose might differ if you have liver problems, if you take other medications that interact with Ingrezza (valbenazine), or if you have certain genetics that will affect the levels of Ingrezza (valbenazine) in your body.
How much does Ingrezza (valbenazine) cost?
$8,461.94
What are alternatives to Ingrezza (valbenazine)?
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