New Drug for Huntington's Chorea
Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, CRRN
Friday October 10, 2008
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The FDA recently approved tetrabenazine (Xenazine), a monoamine blocker that suppresses dopamine, to reduce the uncontrolled jerky and rapid movements associated with Huntington's disease. Available in 12.5 mg and 25 mg scored tablets, tetrabenazine therapy is initiated at 12.5 mg daily, with or without food, and slowly titrated up to 100 mg daily, given as a divided daily dose not to exceed 37.5 mg at any single dose.
Adverse effects: Tetrabenazine is the only FDA-approved treatment specific for Huntington’s disease. It is not a cure, and it has some significant potential adverse effects, including an increased risk of depression and suicidal behavior, prolongation of the QTc interval, dysphagia, parkinsonism, and tardive dyskinesia. Less severe and more common adverse effects include fatigue, nausea, sedation, and insomnia.
Patient monitoring: Patients should be closely monitored for behavior or mood changes and signs of worsening depression or suicidal behaviors. If the patient permits, nurses should also discuss symptoms suggesting suicidal ideation or worsening depression with family members and caregivers.
Patient teaching: Because the incidence of depression is high among individuals with Huntington’s disease, the FDA is requiring a special program to monitor patients prescribed tetrabenazine for worsening psychiatric symptoms. Also encourage them to use caution when driving or operating machinery until they know how tetrabenazine may affect their coordination and wakefulness.
Caution: Review current drug information before administering and monitoring medications.
Drug News is compiled by Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, CRRN, who maintains a private practice in Plantation, Fla., and is professor and area chair for nursing at the University of Phoenix, Fort Lauderdale.
Reference
Tetrabenazine (Xenazine) tablets – product information. FDA Web site. http://www.fda.gov/cder/foi/label/2008/021894lbl.pdf. Accessed: September 17, 2008.
