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Austedo vs Ingrezza
Introduction
For patients with Huntington's disease or Tardive Dyskinesia, certain medications can help in managing symptoms by impacting various neurotransmitters in the brain. Austedo and Ingrezza are two such drugs that are commonly prescribed for these conditions.
Austedo (also known as Deutetrabenazine) works by reducing the amount of dopamine — a chemical messenger in the areas of the brain that control movement and coordination. This helps to improve motor symptoms associated with these disorders.
On the other hand, Ingrezza (also known as Valbenazine) is primarily used to treat Tardive Dyskinesia — a condition characterized by involuntary movements often caused by long-term use of certain psychiatric drugs. It operates on vesicular monoamine transporter 2 (VMAT2), which regulates dopamine release into synapses. Both Austedo and Ingrezza work differently but aim at alleviating neurological disorder-related symptoms.
What is Austedo?
Deutetrabenazine (the generic name for Austedo) and valbenazine (the generic name for Ingrezza) are both medications designed to treat tardive dyskinesia, a condition associated with long-term use of certain mental health drugs that leads to involuntary movements. Deutetrabenazine was approved by the FDA in 2017 following the approval of valbenazine earlier in the same year. Both medications work by reducing the amount of dopamine released into the brain, thereby decreasing unintended muscle activity. However, deutetrabenazine has been engineered to have deuterium atoms at key positions in its structure which slowly metabolizes it, allowing for a smoother effect and potentially lower impact on heart rhythm compared to other treatments like valbenazin. This "trapping" system allows less frequent dosing but results vary from patient to patient depending on their metabolism rate among other factors.
What conditions is Austedo approved to treat?
Austedo is approved for the treatment of certain movement disorders:
- Huntington’s disease-related chorea, a disorder characterized by involuntary jerking or twitching movements
- Tardive dyskinesia, which involves uncontrollable movements that can be caused by using antipsychotic medications over a long period.
In contrast, Ingrezza is solely approved for the treatment of adults with tardive dyskinesia. It does not have an indication for treating Huntington's disease-related chorea.
How does Austedo help with these illnesses?
Austedo works to manage the symptoms of Huntington’s disease and Tardive Dyskinesia by reducing the amount of dopamine available in certain parts of the brain. It does this by inhibiting a specific enzyme known as vesicular monoamine transporter 2 (VMAT2), which is responsible for packaging dopamine into vesicles for release into synapses. Dopamine, like serotonin, is a neurotransmitter that acts as a chemical messenger within the body and plays crucial roles in movement coordination, mood regulation, reward-seeking behavior, among other functions. However, overactivity or an excess amount of dopamine can lead to involuntary movements or spasms associated with conditions like Huntington's disease and Tardive Dyskinesia. Therefore, Austedo's action on VMAT2 helps limit excessive dopamine activity thus managing these involuntary movements effectively and improving overall quality of life.
What is Ingrezza?
Ingrezza, known generically as valbenazine, is a vesicular monoamine transporter 2 (VMAT2) inhibitor which means it acts to regulate the levels of dopamine in the brain. Specifically, VMAT2 inhibitors like Ingrezza function by reducing abnormal movements or dyskinesia associated with disorders such as tardive dyskinesia. The FDA first approved Ingrezza in 2017 and it was the first drug specifically developed for this condition.
Unlike Austedo which can also be used for Huntington’s disease symptoms, Ingrezza's sole indication is for tardive dyskinesia treatment. It does not act on serotonin receptors hence its side-effect profile differs from drugs that do—therefore sedation or sexual dysfunction are not common with Ingrezza use. Its effects on Dopamine regulation can be beneficial especially in patients who have had inadequate response to other forms of treatment.
What conditions is Ingrezza approved to treat?
Ingrezza is approved by the Food and Drug Administration (FDA) for the treatment of:
- Tardive dyskinesia, a serious side effect that can occur with certain medications used to treat mental health conditions
- Huntington's disease-related chorea, an inherited disorder causing uncontrolled movements, emotional problems, and loss of thinking ability.
How does Ingrezza help with these illnesses?
Ingrezza is a medication that acts on the neurotransmitter system, specifically on dopamine regulation in the body. This drug plays significant roles in many processes such as motor control, and it's also heavily involved in inhibiting unnecessary muscle movements to alleviate symptoms of tardive dyskinesia. It works by reducing excessive amounts of dopamine available in the brain, thereby helping patients with involuntary movement disorders. Its unique action mechanism allows Ingrezza to focus primarily on VMAT2 inhibition which makes it different from other drugs like Austedo. Since it doesn't significantly affect serotonin or norepinephrine levels, Ingrezza might be prescribed when a patient does not respond well to typical treatments for tardive dyskinesia (such as Austedo), or may be combined with them.
How effective are both Austedo and Ingrezza?
Both deutetrabenazine (Austedo) and valbenazine (Ingrezza) have established histories of success in treating patients with tardive dyskinesia, a neurological disorder characterized by involuntary muscle movements. Austedo was approved by the FDA in 2017 while Ingrezza received approval only a few months prior. Both drugs act on different neurotransmitters to reduce the symptoms of this condition.
The efficacy of Austedo and Ingrezza in alleviating tardive dyskinesia was compared in separate double-blind clinical trials. These two drugs exhibited similar capacity to manage symptoms as well as promising safety profiles. There were no significant differences between patients receiving either drug regarding improvements in their conditions.
A review published shortly after these medications were approved reported that both are effective at reducing symptoms of tardive dyskinesia within the first week of treatment, had tolerable side effect profiles, and were generally well-accepted by patients due to their relatively low incidence of adverse effects compared to previous treatments for this condition.
Despite being equally effective overall, there are some key differences between these two medications which may impact prescribing decisions. Austedo is typically dosed twice daily whereas Ingrezza is taken once per day, potentially affecting adherence rates among certain patient populations who prefer less frequent dosing regimens. Additionally, although rare, worsening depression or suicidal thoughts can occur with Austedo; thus it should be used cautiously among those with preexisting mental health disorders.
At what dose is Austedo typically prescribed?
Oral dosages of Austedo range from 6–48 mg/day, divided into two doses. However, studies suggest an initial dosage of 6 mg/day is sufficient for treating Huntington's disease chorea or tardive dyskinesia in most adults. The dosage can be upped by 6 mg per day each week if symptoms do not improve. Any daily dose should not exceed 48mg/day. On the other hand, Ingrezza is typically prescribed at a dose of 40-80 mg once per day for adults with tardive dyskinesia. Dosage may begin at a lower point and then increased after one week based on the response and tolerability; however, it should never surpass the maximum recommended daily dose of 80mg.
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At what dose is Ingrezza typically prescribed?
Ingrezza treatment is typically initiated at a dose of 40 mg per day for the first week. Following this initial period, the dosage can be increased to 80 mg once daily, if tolerable and needed. There's no requirement to divide or space out the doses throughout the day as it is taken in one single daily dose. It's important to note that adjustments may be necessary based on individual patient response after several weeks of treatment at 80 mg/day. Always consult with your healthcare provider before making any changes to your medication regime.
What are the most common side effects for Austedo?
Common side effects of Austedo include:
- Sleepiness (somnolence)
- Diarrhea, nausea and vomiting
- Dry mouth
- Fatigue
- Anxiety and restlessness
- Abnormal dreams
- Insomnia or disturbed sleep patterns
- Decreased appetite
In contrast, the common side effects of Ingrezza are:
- Somnolence (sleepiness/drowsiness)
- Heart rhythm problems (QT prolongation)
- Balance disorders or abnormal gait
- Headache
Each individual's reaction to medication can differ significantly. Hence it is essential to consult with your healthcare provider for personalized advice.
Are there any potential serious side effects for Austedo?
While Austedo and Ingrezza are both used to treat movement disorders, they do come with their own potential side effects. For Austedo:
- Watch for any signs of depression or worsening mood including thoughts of suicide.
- Look out for allergic reactions such as hives, difficulty breathing, swelling in your face or throat.
- Be wary of vision changes: blurred vision, eye pain or seeing halos around lights.
- Notify your doctor if you experience heart issues like fast or pounding heartbeats and shortness of breath.
- Low sodium levels can also be a concern - presenting symptoms may include headache, confusion, severe weakness and loss of coordination.
On the other hand with Ingrezza:
- Observe any abnormal control over body movements; these could be wild swings in muscle stiffness (rigidity) ranging from very stiff muscles to flaccid ones
- Monitor for high fever accompanied by sweating and irregular heartbeat
- Alertness fluctuation is another red flag – there might be periods where you feel drowsy followed by sudden alert wakefulness that feels like you might pass out anytime
- Symptoms similar to Parkinson’s disease like slow movements and tremors should not be ignored either.
As always consult your healthcare provider immediately if you experience adverse reactions on either medication.
What are the most common side effects for Ingrezza?
Ingrezza, a medication used to treat chorea associated with Huntington's disease, can cause side effects such as:
- Sleepiness or drowsiness
- Dry mouth and throat
- Blurred vision
- Nausea, abdominal discomfort or pain, reduced appetite
- Constipation
- Balance problems and/or dizziness
- Headaches
- Restless feelings or anxiety
- Increased heart rate
- Confusion or difficulty concentrating.
Other less common but potentially serious side effects may include skin rash, unexplained weight loss, increased frequency of urination. In rare cases it might cause muscle stiffness or pain. Always consult your healthcare provider if you experience any unusual symptoms while taking Ingrezza.
Are there any potential serious side effects for Ingrezza?
While Ingrezza is generally well-tolerated, it's essential to be aware of possible side effects that could indicate a more serious reaction. If you experience any of the following while taking Ingrezza:
- Signs of an allergic reaction: difficulty breathing; hives; swelling of your face, lips, tongue or throat
- Changes in your mental health: new or worsening mood changes, thoughts about harming yourself
- Movement problems: uncontrolled muscle movements in your face (chewing, lip smacking, frowning), tongue (curling), hands and feet
- High blood sugar - increased thirst or urination, hunger with weight loss
- Dizziness leading to severe headache and fainting
Please seek emergency medical help immediately. It's also vital to inform your doctor if you experience other less urgent side effects such as drowsiness or restlessness.
Contraindications for Austedo and Ingrezza?
Both Austedo and Ingrezza, like most medications for Tardive Dyskinesia, may exacerbate symptoms in some people. If you notice an increase in involuntary movements or other neuromuscular issues, please contact your healthcare provider immediately.
Neither Austedo nor Ingrezza should be taken if you are currently taking or have recently stopped taking monoamine oxidase inhibitors (MAOIs), as these can interact negatively with the aforementioned drugs. It's crucial to always inform your doctor about all medications you're on; MAOIs will need approximately 5 weeks to clear from your system completely before starting Austedo or Ingrezza treatment to avoid potential harmful interactions.
How much do Austedo and Ingrezza cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Austedo (12 mg) averages around $5,600, which works out to approximately $186-$372/day depending on your dose.
- Ingrezza's cost is about $6,000 for 30 capsules (80 mg), translating into roughly $200/day.
Thus, if you are in the higher dosage range for Austedo (i.e., 24 mg/day or higher), then brand-name Ingrezza can be less expensive on a per-day treatment basis. It should be noted that cost should not be a primary consideration when deciding between these two medications.
Currently there are no generic versions available for either Austedo (deutetrabenazine) and Ingrezza(valbenazine). Both medications belong to newer class of treatments and hence their prices reflect the ongoing costs associated with research and development as well as patent exclusivity periods. As always, it is crucial to discuss all possible options with your healthcare provider before making any decisions based on cost alone.
Popularity of Austedo and Ingrezza
Deutetrabenazine, sold under the brand name Austedo, and Valbenazine, marketed as Ingrezza, are both prescribed for the treatment of tardive dyskinesia (TD) and Huntington's disease chorea.
Austedo was prescribed to about 25 thousand people in the US in 2020. It accounts for approximately 35% of TD prescriptions in the US. The use of Austedo has been generally increasing since its approval by the FDA in April 2017.
In contrast, Ingrezza was prescribed to nearly 40 thousand patients in America during 2020. This accounted for approximately a little over half of all medication-based treatments for TD within that time period. Since its approval by the FDA a week prior to Austedo's clearance - in April 2017 - Ingrezza has maintained a steady prevalence among prescriptions targeting these neurological conditions.
Conclusion
Both Austedo (deutetrabenazine) and Ingrezza (valbenazine) are approved by the FDA for the treatment of tardive dyskinesia, a condition characterized by abnormal involuntary movements. These drugs have been shown to be effective in reducing symptoms according to numerous clinical trials. Their mechanisms of action differ; Austedo works by depleting the neurotransmitter dopamine while Ingrezza acts as a selective vesicular monoamine transporter 2 inhibitor.
In some cases, these medications may be used together under careful supervision from a healthcare provider, though this is not commonly done due to potential interactions. Typically, the choice between Austedo and Ingrezza will depend on individual patient factors such as their overall health status, other medications they're taking, and their personal response to medication.
Austedo and Ingrezza are both available only as brand-name drugs at present which can lead to higher costs for patients paying out-of-pocket. An adjustment period may also be needed when starting these medications so immediate improvement should not necessarily be expected.
The side effect profiles of both drugs do share similarities including fatigue or sleepiness although Austedo has been associated with more serious adverse effects like depression or suicidal thoughts in rare instances. Both require vigilant monitoring especially during initiation of therapy - any worsening movement disorder symptoms or mood changes should prompt immediate contact with a healthcare professional.