Ingrezza (valbenazine) is a prescription medication approved to treat adults with tardive dyskinesia (TD) and chorea associated with Huntington's disease (HD). It belongs to a class of drugs called vesicular monoamine transporter 2 (VMAT2) inhibitors. Its mechanism involves blocking VMAT2 to regulate dopamine levels in the brain, thereby reducing the involuntary movements associated with these conditions.
Unlike some medications that cure a condition, Ingrezza works by managing the symptoms. When you stop taking it, the regulatory effect on dopamine is removed, and the underlying condition can re-emerge. This is not a sign of addiction or drug dependence, but rather the return of the movement disorder that the medication was controlling. For this reason, discontinuing Ingrezza must always be done under the guidance of a healthcare professional.
The High Risk of Symptom Recurrence
The most significant consequence of stopping Ingrezza is the high likelihood that your original symptoms will return, and potentially worsen initially. The medication manages involuntary movements by reducing the amount of dopamine released into nerve synapses. When this process is no longer inhibited by Ingrezza, the symptoms of TD or HD chorea can return to baseline levels.
For those treating tardive dyskinesia, the involuntary and repetitive muscle movements may reappear in the face, tongue, or other body parts. In patients with Huntington's chorea, the involuntary jerking or twitching motions may resume. For both conditions, studies have shown that the symptom severity returns to nearly pre-treatment levels once the medication is stopped.
The Difference Between Withdrawal and Symptom Rebound
It is important to differentiate between drug withdrawal and the recurrence of a medical condition. In the case of Ingrezza, clinical studies did not report true withdrawal symptoms, which are side effects that occur when a drug your body is dependent on is stopped. The effects experienced are due to the cessation of the drug's therapeutic action, not a withdrawal syndrome related to dependence.
The distinction is crucial for patient understanding and management. While abrupt cessation of other psychotropic drugs can carry specific withdrawal risks, the primary concern with Ingrezza is the predictable return of the movement disorder symptoms it was prescribed to control. This return of symptoms can be distressing and potentially debilitating, which is why a slow and medically supervised approach is necessary.
The Importance of Medical Supervision and Tapering
Because of the high risk of symptom recurrence, abruptly stopping Ingrezza is not recommended. Instead, a gradual tapering process is the safest approach. Your doctor will create a personalized plan to slowly reduce your dose over a period of weeks or months, depending on several factors, including your current dosage, the length of your treatment, and the severity of your condition.
During the tapering process, your healthcare provider will monitor you closely for any changes in your movement symptoms. This allows for a controlled adjustment and provides an opportunity to intervene if symptoms worsen significantly. In some cases, a patient may find that a lower maintenance dose is sufficient, or they may need to explore alternative treatments.
Managing Symptoms After Stopping Ingrezza
If the decision is made to stop Ingrezza, a comprehensive strategy is required to manage the returning symptoms. This may include both pharmacological and non-pharmacological approaches. The initial step is always to collaborate with your healthcare provider to discuss the best course of action for your specific needs.
Alternative Medications
- Other VMAT2 Inhibitors: Another VMAT2 inhibitor, Austedo (deutetrabenazine), is also approved to treat tardive dyskinesia and Huntington's chorea. Your doctor may consider switching you to this medication.
- Antipsychotic Adjustment: For individuals whose TD was caused by a dopamine-blocking agent (antipsychotic), switching to a different antipsychotic with a lower risk of TD (e.g., quetiapine or clozapine) may be an option.
Lifestyle and Behavioral Strategies
- Exercise: Regular physical activity, such as walking, yoga, or swimming, can help improve balance, gait, flexibility, and overall mood.
- Stress Management: Many people find that stress can exacerbate TD symptoms. Techniques like meditation, deep breathing exercises, and building a strong support network can help.
- Dietary and Nutritional Support: Some studies have explored the role of supplements like Vitamin E and Vitamin B6, though evidence is mixed and more research is needed. Avoiding alcohol and caffeine may also be beneficial.
- Adaptations for Daily Living: Making small adjustments to daily tasks, such as using specialized utensils or voice-activated devices, can significantly improve quality of life and manage the impact of movements on daily activities.
The Discontinuation Process: Tapering vs. Abrupt Cessation
| Feature | Tapering (Gradual Discontinuation) | Abrupt Cessation (Stopping Cold Turkey) |
|---|---|---|
| Symptom Recurrence | Symptoms return slowly, often in a more manageable manner. | Symptoms can return quickly and with significant intensity. |
| Monitoring | Enables close monitoring by a doctor to adjust the plan as needed. | Does not allow for proper medical observation or intervention if symptoms worsen. |
| Underlying Mechanism | Allows the body and brain chemistry to gradually readjust to lower dopamine regulation. | Causes a sudden shock to the system, removing the regulatory effect immediately. |
| Overall Risk | Lower risk of sudden, severe symptom exacerbation. | Higher risk of severe symptom return and distress for the patient. |
Conclusion: A Collaborative Decision
Deciding to stop Ingrezza should never be undertaken without consulting the prescribing physician. The primary outcome of ceasing the medication is the return of the movement disorder symptoms it was designed to treat. While the medication is not considered to be associated with classic withdrawal symptoms, the symptom rebound can be significant and distressing. A medically supervised tapering plan is the safest and most effective way to discontinue treatment, allowing for monitoring and the development of alternative management strategies. By working closely with a healthcare team, patients can navigate this transition and continue to manage their condition effectively. For more information on managing tardive dyskinesia, resources like the National Alliance on Mental Illness (NAMI) offer additional support and guidance. National Alliance on Mental Illness (NAMI).
