AUSTEDO XR is a recommended first-line treatment option for adults with tardive dyskinesia1,2

Treat with AUSTEDO XR while maintaining your patient's current regimen3,4

AUSTEDO XR is the only VMAT2 inhibitor with no restrictions or recommendations against use with strong CYP3A4/5 inducers or inhibitors3,5

~75% of drugs are metabolized
through the
CYP3A4/5 or CYP2D6 pathways, which
may increase the likelihood of drug-drug interactions with subsequent medications in the treatment plan6-8
Coadministration per Pathway Recommended Maximum Therapeutic Dose
  AUSTEDO XR3 Ingrezza® (valbenazine)5
Strong CYP3A4/5 inducer No dose restriction Concomitant use is not recommended
Strong CYP3A4/5 inhibitor 40 mg/day
Strong CYP2D6 inhibitor 36 mg/day 40 mg/day
Poor
CYP2D6 metabolizer

These differences should not be construed to imply difference in safety, efficacy, or clinical outcome.

AUSTEDO® XR (deutetrabenazine) extended-release tablets are metabolized primarily through CYP2D6—with minor contributions of CYP3A4/5 and other enzymes to form several minor metabolites.3
Drug classes with significant interactions related to CYP3A4/5 and CYP2D6, as seen in clinical practice of psychiatric and diverse medical conditions

Examples of Drug Classes Associated With CYP3A4/5

Inhibitors

  • Antiarrhythmics9,10
  • Antibiotics9,11
  • Antidepressants9,10
  • Antifungals9,10
  • Antihypertensives9,11
  • Antiretrovirals/ antivirals11,12

Inducers

  • Antibiotics9,10
  • Anticonvulsants/ sedatives9,11,13
  • Antifungals9,10
  • Antihypertensives9,11
  • Corticosteroids9,10
  • Wakefulness-promoting agents11,13

Substrates

  • Antianginals9,11
  • Antidiabetics9,10
  • Antihistamines9,10
  • Antihypertensives9,10
  • Corticosteroids9,10
  • Diuretics11,13
  • Statins11,13
  • Vasodilators10,13

Examples of Drug Classes Associated With CYP2D6

Inhibitors

  • Antiarrhythmics13,14
  • Antidepressants9,11
  • Antifungals9,11
  • Antihistamines9,14
  • Antiparasitics11,13
  • Antipsychotics9,14
  • Calcium reducers9,14

Inducers

Evidence suggests that, unlike most other
CYP450 enzymes, CYP2D6 is not very susceptible
to enzyme induction14

Substrates

  • Antiarrhythmics9,14
  • Antiemetics9,14
  • Antihistamines9,14
  • Antihypertensives9,14
  • Antidepressants9,11
  • Antipsychotics9,14
  • For a list of medications that can help determine potential drug-drug interactions with your patients’ concomitant treatments, see the FlockhartTM Table

Patients in the pivotal studies received the AUSTEDO BID formulation.3

In patients who are poor CYP2D6 metabolizers or are taking strong CYP2D6 inhibitors, the total dosage of AUSTEDO XR should not exceed 36 mg/day.3

VMAT2, vesicular monoamine transporter 2.

The brands listed are registered trademarks of their respective owners.

REFERENCES: 1. Bhidayasiri R, Jitkritsadakul O, Friedman JH, Fahn S. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018;389:67-75. 2. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia. 3rd ed. American Psychiatric Association; 2021. 3. AUSTEDO® XR (deutetrabenazine) extended-release tablets and AUSTEDO® current Prescribing Information. Parsippany, NJ: Teva Neuroscience, Inc. 4. Data on file. Parsippany, NJ: Teva Neuroscience, Inc. 5. INGREZZA® (valbenazine) capsules Prescribing Information. San Diego, CA: Neurocrine Biosciences, Inc.; August 2023. 6. Lee S-J, Goldstein JA. Comparison of CYP3A4 and CYP3A5: the effects of cytochrome b5 and NADPH-cytochrome P450 reductase on testosterone hydroxylation activities. Drug Metab Pharmacokinet. 2012;27(6):663-667. 7. Basheer L, Kerem Z. Interactions between CYP3A4 and dietary polyphenols. Oxid Med Cell Longev. 2015;2015:854015. doi:10.1155/2015/854015 8. Zhou S-F. Polymorphism of human cytochrome P450 2D6 and its clinical significance: part I. Clin Pharmacokinet. 2009;48(11):689-723. 9. US National Library of Medicine. Drugs, herbs and supplements. MedlinePlus. Updated April 28, 2015. Accessed June 9, 2022. https://medlineplus.gov/druginformation.html 10. Horn JR, Hansten PD. Get to know an enzyme: CYP3A4. Pharmacy Times. September 1, 2008. Accessed June 9, 2022. https://www.pharmacytimes.com/view/2008-09-8687 11. US Food and Drug Administration. Drug development and drug interactions: table of substrates, inhibitors and inducers. US Food and Drug Administration. Updated March 10, 2020. Accessed June 9, 2022. https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers 12. PubChem Compound Database. National Center for Biotechnology Information. Accessed June 9, 2022. https://pubchem.ncbi.nlm.nih.gov 13. PubMed Central. National Center for Biotechnology Information. Accessed June 9, 2022. https://www.ncbi.nlm.nih.gov/pmc 14. Horn JR, Hansten PD. Get to know an enzyme: CYP2D6. Pharmacy Times. July 1, 2008. Accessed June 9, 2022. https://www.pharmacytimes.com/view/2008-07-8624