Use of VMAT2 Inhibitors for Tardive Dyskinesia in Geriatrics - A Case Study

Background: Tardive dyskinesia is a persistent, often irreversible movement disorder that may develop after chronic, cumulative exposure to antipsychotics. Geriatric populations are at increased risk of developing tardive dyskinesia as they age, leading to increased risk of injuries secondary to impaired gait and balance. VMAT2 inhibitors such as valbenazine, deutetrabenazine, and tetrabenazine are the first-line treatment and control of tardive dyskinesia. Case Information: After developing tardive dyskinesia on aripiprazole, our patient was started on valbenazine before developing Parkinsonian symptoms and was subsequently switched to deutetrabenazine for management of the tardive dyskinesia. It has taken years of trial and error to adequately manage her tardive dyskinesia without significant untoward effects. Conclusion: As use of VMAT2 inhibitors in managing antipsychotic induced tardive dyskinesia increases, special consideration regarding their efficacy and safety must be taken when starting in older patients. The case presented here highlights the increased risk of development of movement disorders in older adults on even short courses of antipsychotics, as well as the variability in response to VMAT2 inhibitors in resultant treatment. This case also represents the need for caution and concern when prescribing antipsychotics in patients >55, as older adults may have increased susceptibility to the development of tardive dyskinesia even with shorter term second generation antipsychotic use.