Austedo (deutetrabenazine) is a prescription medication FDA-approved to treat two conditions: tardive dyskinesia in adults and chorea associated with Huntington’s disease. Both conditions involve involuntary movements that can interfere with daily life, and Austedo works by reducing the chemical signals in the brain that drive those movements.
Tardive Dyskinesia
Tardive dyskinesia is a condition marked by repetitive, involuntary movements, most often in the face, jaw, tongue, and lips. It develops as a side effect of long-term use of certain psychiatric medications, particularly antipsychotics. The movements can range from mild lip smacking or tongue darting to more pronounced jerking of the limbs or trunk.
In a phase 4 study, up to 77% of participants taking Austedo reported meaningful improvements in the impact of tardive dyskinesia after three months. The benefits extended across several areas of daily life: 75% reported improvements in eating, 65% in psychosocial functioning, 59% in activities of daily living, and 50% in sleep and pain. On a standardized scale used to measure involuntary movements, patients saw an average decrease of 2.9 points in their total motor score.
Chorea in Huntington’s Disease
Chorea refers to the irregular, flowing, dance-like movements that are a hallmark of Huntington’s disease. These involuntary movements can affect the arms, legs, face, and torso, making coordination difficult and increasing the risk of falls.
In a randomized clinical trial published in JAMA, patients taking Austedo saw their chorea scores drop by an average of 4.4 points over 12 weeks, compared to a 1.9-point drop in the placebo group. That translated to a meaningful, visible reduction in involuntary movement for most patients. Mean scores improved from 12.1 at baseline to 7.7, roughly a 36% reduction in chorea severity.
How Austedo Works
Austedo belongs to a class of drugs called VMAT2 inhibitors. Inside nerve cells, a transporter protein called VMAT2 packages dopamine (along with a few other chemical messengers) into tiny storage compartments, holding them until the brain signals their release. Austedo blocks this transporter, which means less dopamine gets stored and less gets released during nerve signaling.
In both tardive dyskinesia and Huntington’s chorea, excess dopamine activity in the brain’s movement-control circuits drives involuntary motion. By trimming dopamine release in these circuits, Austedo strengthens the brain’s “stop” signals and weakens its “go” signals for movement, reducing the abnormal, hyperkinetic motions that define both conditions.
How It Compares to Tetrabenazine
Austedo is chemically related to an older drug, tetrabenazine (Xenazine), which has been used to treat Huntington’s chorea for years. The key difference is a small molecular modification that slows how quickly the body breaks Austedo down. This gives it a longer half-life of 9 to 10 hours, compared to 5 to 7 hours for tetrabenazine.
The practical result is simpler dosing. Austedo is typically taken twice daily, while tetrabenazine often requires three doses per day at higher total amounts. Austedo also has a broader FDA approval: it covers both Huntington’s chorea and tardive dyskinesia, whereas tetrabenazine is only approved for Huntington’s chorea. Tetrabenazine is sometimes used off-label for tardive dyskinesia, but at considerably higher doses. You cannot take Austedo and tetrabenazine (or valbenazine, another VMAT2 inhibitor) at the same time.
Important Safety Information
Austedo carries a boxed warning, the FDA’s most serious safety label, for increased risk of depression and suicidal thoughts in patients with Huntington’s disease. Depression and suicidal ideation already occur at higher rates in Huntington’s disease, and Austedo can worsen both. The drug is contraindicated for anyone who is actively suicidal or has untreated or inadequately treated depression.
Patients, caregivers, and family members should watch for new or worsening depression, changes in mood, or unusual behavior and report these promptly. This warning applies specifically to the Huntington’s disease population, though mood changes should be taken seriously in anyone on the medication.
Who Should Not Take Austedo
Beyond the depression-related contraindication, Austedo is not appropriate for several other groups. It is contraindicated in people with any degree of liver impairment, because the body cannot clear the drug properly and exposure levels rise to potentially dangerous concentrations. People taking MAO inhibitors must wait at least 14 days after stopping those drugs before starting Austedo. Those taking reserpine, a blood pressure medication, need a 20-day washout period.
Some people metabolize the drug more slowly due to genetic differences in a liver enzyme called CYP2D6. For these “poor metabolizers,” the maximum daily dose is capped at a lower level to prevent the drug from building up in the body. Your prescriber may order a genetic test to check your metabolism before or during treatment.
Cost and Patient Support
Austedo can be expensive at its list price, but the manufacturer offers several programs that significantly reduce out-of-pocket costs. The company reports that 93% of patients pay $10 or less. New patients may be eligible for a free 30-day trial voucher, and a copay card for commercially insured patients can bring the monthly cost to as little as $0.
For Medicare Part D enrollees, the Medicare Prescription Payment Plan allows spreading out-of-pocket costs into monthly installments. Patients who qualify for the Extra Help low-income subsidy pay no more than $12.65. For uninsured patients or those who cannot afford the medication, the Teva Cares Foundation, an independent nonprofit, provides Austedo at no cost to eligible individuals.