Tardive dyskinesia (TD) is a persistent, often irreversible movement disorder that can arise as a side effect of certain medications, particularly those used in psychiatric care. For patients in India and worldwide, the emergence of TD can be both physically and emotionally debilitating, affecting daily life and social interactions. With the introduction of Ingrezza (valbenazine), there is renewed hope for those struggling with this challenging condition. Lets explore essential facts about Ingrezza, TD, and what this diagnosis and therapy means for Indian patients.
Tardive Dyskinesia: How Side Effects of Some Drugs Permanently Debilitate Patients 1, 2
Tardive dyskinesia is a neurological disorder marked by involuntary, repetitive movements—most commonly affecting the face, lips, tongue, and sometimes the limbs or trunk. These movements can include grimacing, tongue protrusion, rapid blinking, and lip-smacking. TD is most often caused by long-term use of dopamine receptor-blocking agents, such as antipsychotics prescribed for schizophrenia, bipolar disorder, and depression, as well as some medications for gastrointestinal conditions.
For many, TD is not just a physical burden but also a source of significant stigma and social isolation.
How Tardive Dyskinesia Manifests: Reasons, Duration, and Stages
TD typically develops after months or years of exposure to causative medications. The risk increases with longer duration and higher doses of treatment. Early signs may be subtle, such as slight facial tics or tongue movements, but can progress to more pronounced and disabling symptoms.
TD can be persistent and, in many cases, irreversible, even after the offending drug is stopped.
The disorder often progresses through stages: 2
- -Early Stage: Mild, intermittent movements, often overlooked.
- -Progressive Stage: Movements become more frequent and noticeable.
- -Chronic Stage: Symptoms may stabilize but can remain permanent, severely impacting quality of life.
Types of Tardive Dyskinesia include the following:
1. Classic Tardive Dyskinesia: Most common type, featuring: oro-facial movements (grimacing, tongue writhing), c hewing or puckering of the lips, rapid, jerky movements of the limbs ("piano-playing" fingers).
2.Tardive Dystonia: Prolonged, twisting muscle contractions causing abnormal postures (e.g., neck twisting, arching back). Often more painful and disabling than classic TD.
3.Tardive Akathisia: Subjective feeling of inner restlessness and inability to stay still, can involve pacing, rocking, or constant leg movement.
4.Tardive Tourettism: Speech dysfunction, a rare form of TD resembling Tourette syndrome, with vocal tics (grunts, shouts) and motor tics.
5.Withdrawal-Emergent Dyskinesia
- Occurs after sudden discontinuation of antipsychotics (mostly in children) and is often temporary.
Why is TD underreported in India? 1
Despite its prevalence, TD remains underreported in India. Several factors contribute to this:
- -Lack of Standardized Screening: Tools like the Abnormal Involuntary Movement Scale (AIMS) are not routinely used in Indian clinical practice.
- -Limited Awareness: Both healthcare providers and patients may not recognize early TD symptoms or may attribute them to underlying psychiatric illness.
- -Social Stigma: Cultural attitudes toward mental health and movement disorders may discourage reporting or seeking help.
This underreporting leads to delayed diagnosis and management, further compounding the burden on patients.
20% of Diagnosed Psychiatric Patients in India Develop TD
Studies indicate that approximately 20% of psychiatric patients in India on long-term antipsychotic therapy eventually develop TD, a figure consistent with global data. This high incidence underscores the urgent need for effective screening, prevention, and treatment strategies.
People at Risk: Risk Factors for TD
Certain populations are at higher risk of developing TD, including:
- -Older adults
- -Women
- -Individuals with schizophrenia or mood disorders
- -Those on higher doses or longer durations of antipsychotic therapy
- -Patients with cognitive impairment or diabetes
Hyperlink
Recognizing these risk factors can aid in early monitoring and intervention.
First-Line Treatment: Stopping the Offending Drug
The initial approach to managing TD is to discontinue or reduce the dose of the causative medication, if clinically feasible. In such cases, targeted therapies like Ingrezza become essential.
Ingrezza: Superiority Due to Its Targeted Mechanism 3
Ingrezza (valbenazine) represents a significant advancement in TD management. Uncontrolled movements in TD can be attributed to concentration of dopamine in the nerves. Ingrezza, as a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, works by modulating dopamine release, thereby reducing abnormal involuntary movements.
Clinical trials have shown that Ingrezza provides considerable improvement in TD symptoms, with over 60% of patients experiencing significant benefit within 4 to 6 weeks.
Off-the-label Ingrezza may also be used for Huntington’s disease associated chorea- a movement disorder similar to TD with some differences.
Key advantages of Ingrezza: 4
- -Targeted Mechanism: Unlike older therapies, Ingrezza directly addresses the underlying neurotransmitter imbalance responsible for TD.
- -Once-Daily Dosing in a capsule form: Improves patient adherence and convenience.
- -Proven Efficacy: Demonstrated in multiple clinical trials, including the pivotal KINECT 3 study. 5
- -First FDA-Approved TD Therapy: Ingrezza was the first medication approved specifically for TD by the U.S. FDA in 2017 3
Regaining Control: What It Means for TD Patients 6
For patients, gaining control over involuntary movements is transformative. Improved motor function restores independence, enhances self-esteem, and reduces the social stigma associated with TD.
Many patients report a renewed ability to perform daily activities, engage in social interactions, and pursue employment or education.
Ingrezza as Monotherapy: No Need for Combination 3
Ingrezza is approved as a monotherapy for TD, meaning it does not need to be combined with other drugs to be effective. This simplifies treatment regimens and reduces the risk of drug interactions, making it an attractive option for patients with complex medication profiles.
Safety and Adverse Effects
Ingrezza is generally well tolerated. The most common side effects include:
- -Sleepiness (somnolence)
- -Dry mouth
- -Constipation
- -Disturbance in attention
- -Blurred vision
Rare but serious risks include extreme drowsiness or loss of consciousness & heart rhythm problems (QT prolongation), so caution is advised in patients with a history of cardiac arrhythmias or those taking medications that affect heart rhythm. Adverse reactions should be immediately reported to the treating physician for prompt resolution.
Adverse reactions leading to discontinuation are uncommon, occurring in approximately only 3% of patients in clinical trials. 3
Accessing Ingrezza in India -
For Indian patients, access to Ingrezza may be possible through special import programs like Rx4u, which facilitate the availability of rare disease therapies under the Named Patient Program (NPP).
Rx4u's NPP bridges the gap between Indian patients & rare, locally unavailable medicines like Ingrezza only available abroad. With their brilliant legal team and Global Supply chain, Rx4u ensures timely delivery of authentic medications for patients who need them in India.
Visit https://rx4u.in/ for more information.
Note:
The information provided is for education purpose only and is subjected to prescribing information of the drug and the guidance of your treating physician. Always consult your health care provider before making any medical decision for starting your treatment.
References
1.https://journals.lww.com/aips/fulltext/2020/04010/tardive_dyskinesia__prevention_and_newer.3.aspx
2.https://www.ncbi.nlm.nih.gov/books/NBK448207/
3.https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/209241s020lbl.pdf
4.https://www.drugs.com/ingrezza.html
5.https://pubmed.ncbi.nlm.nih.gov/28320223/
6.https://www.ingrezza.com/tardive-dyskinesia/patient-stories
