10 Ingrezza Side Effects and How to Manage Them

Tardive dyskinesia and Huntington’s disease can show up in daily life in ways that are tough to brush off. Uncontrolled facial movements, changes in posture, or sudden limb motions can attract unwanted attention. They can also make simple tasks, such as speaking clearly, eating comfortably, or walking steadily, feel harder than they should. Over time, that can wear on you both physically and emotionally.

Ingrezza (valbenazine) is one medication that can help lessen movement problems from these conditions. It’s thought to do so by balancing dopamine activity in the brain. For many people, Ingrezza can make a meaningful difference. But like any medication that affects the nervous system, it can cause side effects.

Most Ingrezza side effects are mild and tend to improve as your body gets used to the medication. Others are less common but more serious and require medical care. Understanding what to look out for can help you feel more prepared as you begin treatment.

Ingrezza side effects at a glance

The side effects you might experience with Ingrezza can depend on why you’re taking it. Overall, though, common or mild Ingrezza side effects include:

• Sleepiness

• Lethargy

• Insomnia

• Restlessness

• Skin rashes or hives

• Dry mouth

• Constipation

• Nausea

• Diarrhea

• Blurry vision

• Trouble urinating

• Headaches

• Back or joint pain

Rare but serious Ingrezza risks include:

• Heart rhythm changes

• Drug-induced movement problems

• Neuroleptic malignant syndrome, causing symptoms such as high fever and muscle rigidity

• Allergic reactions

This oral medication also carries a boxed warning for mood-related risks. (A boxed warning is the FDA’s strictest warning for medications.) While rare, Ingrezza can cause depression or thoughts of suicide in people living with Huntington’s disease.

Here, we’ll dive deeper into 10 notable Ingrezza side effects and how to manage them.

1. Sleepiness or feeling lethargic

Feeling unusually tired is one of the most commonly reported side effects of Ingrezza. You might feel drowsy during the day, low on energy, or mentally slowed down. Some people describe it as feeling foggy or less alert than usual.

This side effect is more common when first starting Ingrezza or after a dosage increase. For many people, it improves as the body adjusts to the medication.

If you experience sleepiness that becomes hard to tolerate, consider:

• Taking your doses in the evening, if your prescriber gives you the OK

• Building short rest breaks into your day, instead of pushing through exhaustion

• Attempting light physical activity, such as a brief walk, to boost alertness

• Staying well hydrated

• Keeping a consistent sleep schedule at night to avoid worsening daytime fatigue

It’s also good to limit alcohol intake and be cautious with other medications that worsen drowsiness, such as antihistamines, opioids, and certain anxiety medications. And until you know how Ingrezza affects you, you should avoid driving or doing other tasks that require alertness.

2. Difficulty sleeping

Interestingly, not everyone feels sleepy after starting Ingrezza. Some people have trouble falling or staying asleep instead.

If your sleep routine shifts in this opposite direction after starting Ingrezza, small adjustments may help. Try keeping a consistent bedtime and limiting screen time before bed. Cutting back on afternoon caffeine can also make a difference.

If your insomnia continues for more than a couple of weeks, talk with your healthcare team. Changing when you take the medication may improve your sleep.

3. Dry mouth

Ingrezza can cause anticholinergic side effects, which happen when certain nerve signals are blocked. Dry mouth is one of the most common anticholinergic side effects that people experience with Ingrezza.

Dry mouth can seem minor. But it can be uncomfortable. You might notice a sticky feeling, bad breath, or even cavities if it persists over time.

These small, daily habits can make a big difference in managing or preventing dry mouth:

• Sipping water regularly throughout the day

• Chewing sugar-free gum or sucking on sugar-free lozenges to stimulate saliva

• Choosing an alcohol-free mouthwash

• Using a humidifier at night if your mouth feels dry while sleeping

• Limiting your intake of tobacco, alcohol, and caffeinated drinks, which can worsen dryness

If you have dryness that becomes severe or leads to mouth sores, a healthcare professional can recommend additional treatments.

4. Constipation

Changes in bowel habits, like constipation, are another possible issue with Ingrezza. Constipation may show up as hard stools, bloating, or going to the bathroom less than usual. The medication can also cause stomach-related side effects such as nausea or diarrhea in some cases.

If you’re feeling constipated, it’s helpful to address it early, rather than waiting for it to become uncomfortable. You can try:

• Drinking plenty of fluids throughout the day

• Gradually increasing your intake of fiber-rich foods, such as fruits, vegetables, and legumes

• Staying physically active, as even light walking can help stimulate bowel movements

• Setting aside time each day to use the bathroom without rushing

If lifestyle changes like these don’t do enough, a pharmacist can recommend over-the-counter (OTC) treatment options, such as a stool softener or gentle laxative.

Severe abdominal pain, vomiting, or several days without a bowel movement should prompt a call to your prescriber.

5. Balance problems

Because Ingrezza affects brain signaling, some people notice coordination or balance changes with the medication. These changes can increase fall risk, especially in older adults.

If you feel unsteady:

• Stand up slowly when you’re moving from a sitting or lying down position.

• Make sure walkways at home are clear.

• Use handrails when available.

• Ask your prescriber about balance exercises to improve stability.

Let your prescriber know if you're experiencing new or unusual balance problems. Falls should always be taken seriously, too — particularly if you hit your head.

6. Restlessness

Ingrezza can cause restlessness in some people. This can feel like inner tension or a strong urge to keep moving. You might find it hard to sit still, relax, or focus on one task. This side effect is sometimes called akathisia. For some people, it comes and goes. For others, it can interfere with daily routines.

If you feel more restless after starting Ingrezza, try:

• Taking short, planned movement breaks (such as 5- to 10-minute walks) instead of fighting the urge to move

• Stretching your arms and legs

• Doing gentle range-of-motion exercises

• Practicing slow, paced breathing

• Cutting back on caffeine and other stimulants

• Keeping a simple log of when symptoms happen to see if there’s a pattern

Structured activities can also help redirect restless energy. Folding laundry, organizing a drawer, or doing a puzzle may make the sensation feel more manageable.

If you have restlessness that is persistent, worsens, or affects your sleep, contact your prescriber. A dosage adjustment or medication review may help. But seek emergency medical care right away if your restlessness occurs along with severe muscle stiffness, high fever, or confusion.

7. Skin rashes or hives

A rash from Ingrezza may appear as red, itchy, or raised patches. In many cases, it’s mild and goes away on its own. Still, to manage it, you can:

• Stick to fragrance-free moisturizers.

• Avoid new soaps or lotions until your skin clears.

• Apply a cool compress to the affected area to help reduce itching and swelling.

• Wear loose, breathable clothing (such as cotton items) to avoid irritating the skin further.

• Ask your pharmacist or prescriber about taking antihistamines for itching.

Certain symptoms coinciding with a rash warrant urgent care. Swelling of the lips or throat, trouble breathing, or widespread hives may signal a serious allergic reaction. Call 911 or seek emergency care right away if any of these occur.

8. Heart rhythm changes

Ingrezza can affect electrical signals in the heart. Specifically, it can cause QT prolongation (a type of arrhythmia) in people who take high doses of the medication.

Most people with this condition never notice symptoms. But warning signs can include:

• Fainting

• Dizziness

• A fast or irregular heartbeat

Your risk may be higher if you take other medications that can affect heart rhythm, or if you have low potassium or magnesium levels. So it’s important to share your updated medication list with your prescriber and pharmacist — and attend all recommended lab (monitoring) appointments.

Sudden fainting or heart palpitations should be treated as a medical emergency.

9. Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a rare but serious side effect of certain medications that affect dopamine. This includes Ingrezza.

NMS is a life-threatening reaction that causes severe muscle rigidity and a sudden rise in body temperature due to changes in brain signaling. Other possible symptoms include confusion, heavy sweating, and a rapid or irregular pulse.

Experiencing symptoms of NMS warrants immediate medical care. If you or someone around you notices these symptoms, call 911 or go to the nearest ER.

10. Depression or thoughts of self-harm

Ingrezza carries a boxed warning for depression and suicidal thoughts in people with Huntington’s disease. While these side effects are rare, they’re serious. It’s also important to know that people living with Huntington’s disease already have a higher risk of depression due to changes in the brain caused by the condition itself.

Contact your prescriber right away if you experience any sudden mood changes while taking Ingrezza. Be on the alert for alarm bells such as:

• New or worsening sadness

• Loss of interest in your normal leisure activities

• Irritability or mood swings

• Changes in sleep or appetite

• Talking about feeling hopeless or wanting to harm yourself

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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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

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