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Pharmacological interventions
Vesicular monoamine transporter type 2 inhibition can lead to effective and tolerable management of tardive dyskinesia
  1. Leslie Citrome
  1. Correspondence to Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY 10595, USA; citrome{at}

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Commentary on: Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Psychiatry. 2017 Aug;4(8):595–604.

What is already known on this topic  

Tardive dyskinesia (TD), characterised by involuntary movements of the tongue, lips, face, trunk and extremities, is thought to be a generally irreversible consequence of the use of dopamine receptor blocking agents and is not rare. The introduction of second-generation antipsychotics has not  eliminated TD. Vesicular monoamine transporter type 2 (VMAT2) inhibition has been known to reduce TD, as observed with tetrabenazine, but tetrabenazine has been relatively complex to use because of its short half-life and sensitivity to CYP2D6 metabolism.1 Deutetrabenazine is related to tetrabenazine in that deuterium is substituted for hydrogen at the key sites of primary metabolism, altering the pharmacokinetics of drug metabolism by slowing it down.

Methods of the study

In this randomised, double-blind, placebo-controlled study, …

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  • Competing interests No external funding or writing assistance was used in the production of this commentary. In the past 12 months, Leslie Citrome has served as a consultant to: Acadia, Alkermes, Allergan, Intra-Cellular Therapeutics, Janssen, Lundbeck, Merck, Neurocrine, Noven, Otsuka, Pfizer, Shire, Sunovion, Takeda, Teva and Vanda. In the past 12 months, Leslie Citrome has served as a speaker for: Acadia, Alkermes, Allergan, Janssen, Lundbeck, Merck, Neurocrine, Otsuka, Pfizer, Shire, Sunovion, Takeda, Teva and Vanda. Other disclosures: stocks (small number of shares of common stock): Bristol-Myers Squibb, Eli Lilly, J & J, Merck, Pfizer purchased >10 years ago; and royalties: Wiley (Editor-in-Chief, International Journal of Clinical Practice), UpToDate (reviewer) and Springer Healthcare (book).

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.