Austedo - The first and only medication approved to treat bothe tardive diskinesia in adults

Austedo is an approved medication to treat tardive diskinesia in adutls and chorea associated with Hungtington's disease

1. Toai Nguyen - Pharmacy intern Mayra Valle - Preceptor

2. Type to enter a caption. Huntington’s Disease (HD) HD is a fatal genetic disorder that causes the progressive breakdown of the nerve cells in the brain. HD is a disorder in which there is an excessive repetition of tri-nucleotides on the DNA - the sequence repeats of CAG is more than 36 times.

3. Symptoms Huntington’s Disease (HD) 3 main categories of HD symptoms

4. Chorea Continuous, irregular and unpredictable involuntary movements that flow from one body part to another. People can sometimes suppress the movements for a short period of time.

5. https://youtu.be/lFJEF-_y_Os https://www.youtube.com/watch?v=bWgJMVch_B8

6. Tardive Dyskinesias - TD Dopamine plays a key role in different brain functions including: motor, cognitive and emotional. An imbalance of dopamine in cognitive/emotional pathway causes the symptoms experienced by patients with schizophrenia, bipolar, or depression. Treatment of those symptoms with antipsychotics may cause a new imbalance in the motor pathway, leading to symptoms of TD.

7. Type to enter a caption. Tardive Dyskinesias

8. https://www.youtube.com/watch?v=d8_SdUNcCY0

9. VMAT2 transfer dopamine into synaptic ventricle; Dopamine is released to synaptic cleft; bind to receptor on postsynaptic neuron signaling movement. Excess dopamine signaling manifested involuntary movements as abnormal. Austedo - How it works?

10. Deutetrabenazine - VMAT2i - Vesicle Monoamines Transporter 2 inhibitor AUSTEDO is indicated for the treatment of chorea associated with Huntington’s disease and for the treatment of tardive dyskinesia in adults. It comes in 6mg, 9mg, 12mg tablets.

11. If a patient is a poor CYP2D6 metabolizer or is using a concomitant strong CYP2D6 inhibitor the daily dose of Austedo should not exceed 36mg. Some examples of strong CYP2D6 inhibitors are: Bupropion Fluoxetine Paroxetine Quinidine Terbinafine Cautions

12. Cautions If a patient is on a dose of more than 24mg/day and is taking another medication that may cause QT prolongation, we must asses QTc interval before and after adjusting the dose for Austedo or other drugs. Some drugs that can cause QT prolongation are: Haloperidol, Olanzapine Quinidine, Procainamide, Amiodarone, Sotalol Amitriptyline, Doxepin, Nortriptyline, Desipramine Quinolone, Macrolide

13. Contraindications If the patient has untreated depression and has suicidal thoughts. Liver problems Taking MAOi within 14 days (selegiline,phenelzine..) Taking reserpine within 20 days Taking tetrabenazine (Xenazine), valbenazine, Ingrezza)

14. Side Effects Irregular heartbeat (QT prolongation) Neuroleptic Malignant Syndrom Restlessness Parkinson in people with Huntington’s disease Sleepiness (sedation), diarrhea, tiredness and dry-mouth is common with Huntington’s disease Inflammation of the nose and throat (nasopharyngitis) and problems sleeping (insomnia) with TD

15. Counseling points Take with food, swallow whole and do not chew, crush or break the tablets. May increase risk of depression, suicidal thoughts . Patient or caregiver should inform healthcare provider of any related symptoms. May cause irregular heart beat. Patient should consult the doctor immediately if they feel faint or develop palpitations. May cause sedation. Patient should avoid activities that requires alertness. Patient should notify physician or pharmacist of any additional medications he/she is taking including OTC, herbal to avoid drug-drug interaction.

16. References http://hdsa.org/what-is-hd/ https://online-lexi-com https://www.austedo.comhttps://www.fda.gov/ https://dailymed.nlm.nih.gov/dailymed/drugInfo

17. Questions?