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Tetrabenazine is a medication that requires careful consideration due to its potential risks and side effects. Below is essential safety and warning information to ensure its safe use. Consult with your healthcare provider to understand the risks and benefits specific to your situation.

• Risk of Depression and Suicidal Thoughts: Tetrabenazine can increase the likelihood of depression and suicidal thoughts, especially in individuals with Huntington's disease. It is crucial to discuss these risks with your doctor. If you experience new or worsening symptoms of depression, suicidal thoughts, or changes in mood or behavior, contact your healthcare provider immediately. Those with untreated or inadequately treated depression or suicidal tendencies should not use this medication.

• Worsening Huntington's Disease Symptoms: Tetrabenazine may exacerbate the symptoms of Huntington's disease, such as mood changes, cognitive difficulties, chorea, and muscle stiffness. Regular monitoring by your healthcare provider is necessary. Dosage adjustments or temporary discontinuation might be required to determine if symptoms are due to the disease or medication.

• Genetic Testing: For individuals not responding to the standard dose of 50 mg per day, genetic testing may be needed to assess how your body metabolizes tetrabenazine. This can inform appropriate dosage adjustments.

• Neuroleptic Malignant Syndrome (NMS): A rare but serious condition called NMS may occur, characterized by high fever, sweating, muscle stiffness, confusion, and irregular heartbeat. Immediate medical attention is required if these symptoms appear.

• Movement Disorders: Tetrabenazine can cause restlessness and movement issues like akathisia. Notify your doctor if you experience these symptoms.

• Heart Rhythm Changes (QT Prolongation): There is a risk of life-threatening heart rhythm changes, particularly in individuals with a low heart rate, low potassium or magnesium levels, or those taking other medications affecting heart rhythm. Report any chest pain, shortness of breath, or fainting to your healthcare provider immediately.

• High Prolactin Levels: This medication may increase prolactin levels, potentially leading to breast growth, milk production, and weakened bones. Contact your healthcare provider if you notice these symptoms.

Contraindications:

• Do not use tetrabenazine if you have untreated or inadequately managed depression or suicidal thoughts.
• Avoid if you suffer from liver failure.
• Do not take this medication if you have used monoamine oxidase inhibitors (MAOIs) in the past 14 days, or if you are currently taking Austedo or Ingrezza.

Always inform your healthcare provider of all medications and supplements you are taking to avoid potential interactions. In case of any severe or unusual symptoms, seek medical attention immediately.

When taking this medication, some individuals may experience common side effects that are generally mild and manageable. These include drowsiness, difficulty sleeping, tiredness, dizziness, nausea, vomiting, restlessness, anxiety, and irritability. It is common to feel tired or experience sleep disturbances, while nausea and vomiting may also occur. Some may notice symptoms like a cold, balance issues, or mild bruising. In most cases, these effects are not severe, but if they persist or worsen, consulting a healthcare provider is advised.

More serious side effects, though less common, require immediate medical attention. These include mental or mood changes such as depression, suicidal thoughts, or anxiety. Symptoms akin to Parkinson's disease, like slowed movements or tremors, and trouble swallowing are also concerning. In rare instances, a condition called neuroleptic malignant syndrome (NMS) may occur, marked by high fever, muscle stiffness, severe confusion, or an irregular heartbeat. Alert a medical professional if these symptoms arise.

This medication can also cause allergic reactions, though they are rare. Signs include a rash, itching, swelling of the face, or trouble breathing. Immediate medical help is necessary if these occur. Other less common side effects include dizziness, headache, slurred speech, and shortness of breath. If experiencing any unusual or severe symptoms, seeking prompt medical advice is essential to ensure safety and appropriate care.

Tetrabenazine (Xenazine) can interact with various medications, and it is crucial 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.

It is strongly advised not to use tetrabenazine alongside certain medications due to the risk of serious interactions. These include valbenazine, deutetrabenazine, and MAO inhibitors such as isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, and tranylcypromine. Combining tetrabenazine with these drugs can lead to potentially life-threatening interactions. Generally, MAO inhibitors should not be used for two weeks before and after taking tetrabenazine. Please consult your doctor for specific guidance on when to start or stop these medications.

Additionally, tetrabenazine should not be combined with drugs such as bepridil, brofaromine, cisapride, clorgyline, dronedarone, and others listed, as these combinations are not recommended. In certain scenarios, your doctor may need to adjust your medication regimen.

In some cases, tetrabenazine may be used with other medications, but it may require dosage adjustments due to the increased risk of side effects. One such medication is paroxetine. Your healthcare provider will guide you on the best approach for your treatment plan.

Always follow your healthcare provider's instructions and discuss any concerns you may have regarding drug interactions.