Management of chorea in patients with Huntington disease

PRN: as needed; VMAT2: vesicular monoamine transporter type 2.

* VMAT2 inhibitors approved for use in patients with Huntington disease are tetrabenazine, deutetrabenazine, and valbenazine. Deutetrabenazine and valbenazine have longer half-lives. VMAT2 inhibitors are subject to drug interactions that require dose adjustment or avoidance; specific interactions may be determined using the drug interactions program included within UpToDate. Availability and cost may vary by region.

¶ When switching from a VMAT2 inhibitor to antipsychotic therapy, begin antipsychotic therapy and then gradually taper VMAT2 inhibitor. Preferred second-generation antipsychotic drugs for chorea are aripiprazole, olanzapine, and risperidone.

Δ Some experts may consider a VMAT2 inhibitor in patients with comorbid depression who have refractory chorea; others consider depression a strict contraindication to VMAT2 inhibitor use in this population.