American Psychiatric Association (APA) and American Academy of Neurology (AAN) guidelines: VMAT2 inhibitor as first-line treatment for tardive dyskinesia (TD)1,2

VMAT2 inhibitor class: Backed by AAN with highest level of therapeutic evidence* and recommended by APA regardless of severity of TD1,2

AAN: Level of evidence for TD2†
VMAT2 inhibitor A
Ginkgo biloba B
Tetrabenazine C
Pallidal deep
brain stimulation
C (intractable TD)
  • APA guidelines recommend considering starting patients on a VMAT2 inhibitor to address TD-associated impairments and impact on psychosocial functioning1
  • Recommended update to AAN guidelines recognizes VMAT2 inhibitors as first-line treatment for TD2


Level A is the strongest recommendation, established as effective, based on at least 2 consistent class I studies. Level B refers to probably effective treatment, derived from at least 1 class I study or 2 consistent class II studies. Level C recommendation indicates that the treatment is possibly effective, based on at least 1 class II study and 2 consistent class III studies.2

The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation.2

TD symptoms that have an impact on the patient should be managed with a VMAT2 inhibitor1,2

VMAT2, vesicular monoamine transporter 2.

REFERENCES: 1. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia. 3rd ed. American Psychiatric Association; 2021. 2. 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.