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Overview: Tetrabenazine is a medicine used to treat chorea caused by Huntington’s disease. The medicine works to block certain chemicals in the brain, which helps cause less movement. Common side effects include sleepiness, depression, anxiety, and nausea. Serious side effects are less common but can include allergic reactions, suicidal thoughts, movement problems, and heart rhythm problems. Call your health care provider right away if you have suicidal thoughts. 

Uses

What is tetrabenazine used for?

Tetrabenazine is commonly used to treat chorea, a movement disorder associated with Huntington’s disease. 

Tetrabenazine may also be used for other conditions as determined by your health care provider.

How does tetrabenazine work (mechanism of action)?

Tetrabenazine is a vesicular monoamine transporter 2 (VMAT2) inhibitor that works to change the activity of certain chemicals in the brain that affect muscles, nerves, and movement. This causes less uncontrolled movements.

How is tetrabenazine supplied (dosage forms)?

Brands and other names

  • Xenazine

Dosage forms and strengths

  • 12.5 mg, 25 mg oral tablets

How should I store tetrabenazine?

Tetrabenazine should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool and dry place.

Side Effects

What are the most common side effects of tetrabenazine?

The most common side effects of tetrabenazine are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Sleepiness and tiredness (see below)
  • Trouble sleeping
  • Depression
  • Restlessness
  • Anxiety
  • Nausea

There may be other side effects of tetrabenazine that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of tetrabenazine?

While less common, the most serious side effects of tetrabenazine are described below, along with what to do if they happen.

Severe Allergic Reactions. Tetrabenazine may cause allergic reactions, which can be serious. Stop taking tetrabenazine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Suicidal Thoughts and Actions. Tetrabenazine may cause suicidal thoughts or actions in a small number of people. If you are about to harm yourself, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your health care provider right away if you have any of the following symptoms.

  • New or increased thoughts of suicide or death
  • Suicide attempt
  • New or increased feelings of anxiety, depression, or other unusual changes in mood or behavior

Neuroleptic Malignant Syndrome (NMS). Antipsychotic medicines, such as tetrabenazine, can cause a rare but serious condition called neuroleptic malignant syndrome. NMS can lead to death. Stop taking tetrabenazine and call your health care provider right away if you have any of the following symptoms.

  • High fever
  • Muscle stiffness or rigidity, making it hard to move
  • Changes in your breathing or heart rate
  • Increased sweating
  • Confusion

Agitation and Restlessness. Tetrabenazine may increase your risk of restlessness, which may make it hard for you to relax. The medicine may also cause you to feel agitated. Call your health care provider right away if you develop any of these symptoms. 

Parkinson-Like Symptoms. Tetrabenazine may cause involuntary movement problems, including shakiness, stiffness, or jerkiness. It can also cause drooling, falling, or walking or balance problems. These are called Parkinson-like symptoms, or parkinsonism. Call your health care provider right away if you develop any Parkinson-like symptoms.

Sleepiness and Tiredness. Tetrabenazine can make you drowsy or sleepy. Do not drive or do other activities that require alertness or coordination until you know how tetrabenazine affects you.

Heart Rhythm Changes. Tetrabenazine may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take medicines that can prolong the QT interval. Tell your health care provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Low Blood Pressure Upon Standing (Orthostatic Hypotension). Tetrabenazine may cause a sudden drop in blood pressure when standing up from a seated or lying position. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your health care provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

High Prolactin Levels (Hyperprolactinemia). Tetrabenazine may cause an increased level of the hormone prolactin in your blood. High levels of prolactin could lead to fertility or bone problems. Contact your health care provider if you have any of the following symptoms.

  • Vaginal dryness
  • Irregular or no periods 
  • Production of breastmilk when not pregnant or nursing
  • Inability to get or keep an erection
  • Enlarged breast size (gynecomastia)
  • Decreased muscle mass and body hair

Warnings & Precautions

Who should not use tetrabenazine?

Allergies to Ingredients. People who are allergic to any of the following should not take tetrabenazine.

  • Tetrabenazine
  • Xenazine
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific tetrabenazine products they stock.

Drug Interactions. Tetrabenazine should not be taken while you are using certain other medicines. Before taking tetrabenazine, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Liver Problems. Tetrabenazine should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to determine if it is working well enough to take this medicine.

Suicidal Thoughts and Actions. Do not take tetrabenazine if you are depressed or are having thoughts of suicide. 

What should I know about tetrabenazine before using it?

Do not take tetrabenazine unless it has been prescribed to you by a health care provider. Take it as prescribed. Your health care provider will adjust your dose weekly until you reach the dose that works best for you.

Do not share tetrabenazine with other people, even if they have the same condition as you. It may harm them.

Keep tetrabenazine out of the reach of children.

Tetrabenazine does not cure the cause of uncontrolled movements or treat other symptoms of Huntington’s disease, such as problems with thinking or emotions.

What should I tell my health care provider before using tetrabenazine?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if tetrabenazine is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • A history of mental health conditions such as depression, anger, agitation, anxiety, or psychosis or suicidal thoughts/suicidal attempts
  • Liver disease
  • Breast cancer or a history of it
  • Heart problems, including heart failure or recent heart attack
  • Irregular heart rhythm or heartbeat
  • Low blood pressure
  • High prolactin levels

Pregnancy. It is not known if or how tetrabenazine could affect pregnancy or harm a fetus. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if tetrabenazine passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does tetrabenazine interact with foods or drinks?

There are no known interactions between tetrabenazine and foods or drinks.

It is unknown if drinking alcohol will affect tetrabenazine. The risk of sleepiness and tiredness may increase if you drink alcohol while taking tetrabenazine.

Does tetrabenazine interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking tetrabenazine.

  • A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
  • Fluoxetine or paroxetine, which are medicines commonly used for anxiety and depression
  • Quinidine, which is a medicine used to treat malaria or control your heart rate or rhythm 
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, or medicines for anxiety
  • Any medicine such as amiodarone (Pacerone and others), chlorpromazine, haloperidol (Haldol), moxifloxacin, sotalol (Betapace), thioridazine, or ziprasidone (Geodon) that can cause QT prolongation, which is a potentially dangerous heart rhythm problem
  • An antipsychotic, such as olanzapine (Zyprexa) or risperidone (Rykindo), which is a medicine for certain mental health conditions
  • Deutetrabenazine (Austedo) or valbenazine (Ingrezza), which are medicines used to treat certain movement disorders such as tardive dyskinesia (TD) and chorea

Some other medicines may alter the blood levels of tetrabenazine. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with tetrabenazine. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much tetrabenazine?

If you or someone else has used too much tetrabenazine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of tetrabenazine?

Talk to your health care provider on what to do if you miss a dose. If it is almost time for your next dose, do not take double or extra doses.