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Tetrabenazine, also known as Xenazine, is a medication that requires careful consideration of its safety and potential risks. Below is important information you need to know before using this medication. Please ensure to discuss any concerns with your healthcare provider.

• Depression and Suicidal Thoughts: Tetrabenazine may increase the risk of depression and suicidal thoughts, particularly in individuals with Huntington's disease. It is crucial for healthcare providers to monitor patients for these symptoms throughout treatment. If you or those around you notice any signs such as worsening depression, suicidal thoughts, anxiety, panic attacks, or changes in behavior, contact your healthcare provider immediately. Discontinuation of the medication may be necessary if symptoms persist.

• Huntington's Disease Symptoms: Tetrabenazine can potentially worsen some symptoms of Huntington's disease, such as mood changes, cognitive difficulties, and muscle stiffness. Regular assessments by your healthcare provider are essential to determine the medication's safety and effectiveness. Adjustments in dosage or a temporary discontinuation of the medication may be needed based on symptom evaluation.

• Genetic Testing for Dosage: For those who require more than 50 mg of tetrabenazine daily, genetic testing might be necessary to assess how your body metabolizes the drug. Based on the test results, your dosage may be adjusted to improve treatment effectiveness.

• Neuroleptic Malignant Syndrome (NMS): This medication can cause a rare but serious condition called NMS, characterized by high fever, muscle stiffness, confusion, and irregular heartbeat. The risk increases with the use of other medications such as antipsychotics. Immediate medical attention is required if symptoms occur.

• Movement Disorders (Parkinsonism): Tetrabenazine may cause restlessness, agitation, or a condition known as akathisia. If these symptoms arise, consult your healthcare provider.

• Heart Rhythm Abnormalities (QT Prolongation): Although rare, tetrabenazine can lead to QT prolongation, affecting heart rhythms. Those with low heart rates, low potassium or magnesium levels, or those taking other QT-prolonging drugs are at higher risk. Any symptoms like chest pain, fainting, or shortness of breath should be treated as emergencies.

• High Prolactin Levels: The drug may increase prolactin levels, potentially leading to breast growth or milk production in both sexes, and may affect bone density and sexual interest. Notify your healthcare provider if you experience these symptoms.

Contraindications: Do not use tetrabenazine if you have untreated or unresolved depression, suicidal thoughts, liver failure, or if you are taking MAOIs or other similar medications such as Austedo or Ingrezza. Always consult your healthcare provider before starting or stopping any medication.

Common side effects:

• drowsiness
• trouble sleeping
• tiredness
• dizziness
• nausea
• vomiting

• mild mood changes such as anxiety or irritability

  Less common but important to monitor:

• headache
• slurred speech
• unsteady gait
• shortness of breath
• low appetite
• feelings of restlessness

• increase in depression symptoms

  Serious side effects:

• neuroleptic malignant syndrome symptoms (high fever, muscle stiffness, severe confusion, abnormal heart rhythms)
• severe mood changes
• suicidal thoughts
• chest pain
• difficulty breathing
• serious allergic reactions (rash, swelling, trouble breathing)

Tetrabenazine (Xenazine) can interact with other medications or supplements. It is important to inform your doctor and pharmacist about all the medications and supplements you are currently taking, including prescription, over-the-counter, vitamins, and herbal products. Below are some key interactions to be aware of:

1. MAO Inhibitors: Combining tetrabenazine with MAO inhibitors, such as isocarboxazid, linezolid, phenelzine, and others, can lead to a serious and potentially fatal drug interaction. Avoid using MAO inhibitors during treatment with tetrabenazine and for two weeks before and after its use. Consult with your doctor on when to start or stop these medications.

2. Similar Medications: Tetrabenazine should not be used with deutetrabenazine as they are very similar. Using both can increase the risk of side effects.

3. Other Drug Interactions: The use of tetrabenazine with certain medications like valbenazine, bepridil, and others listed in the sources is not recommended. Your doctor may choose alternative treatments or adjust your medications accordingly.

4. Potential Side Effects: Some drugs, such as paroxetine, may increase the risk of side effects when used with tetrabenazine. Your doctor may need to adjust dosages or monitor your usage carefully if these are prescribed together.

Always consult with your healthcare provider to ensure safe and effective use of tetrabenazine alongside other treatments.