Valbenazine Tosylate interactions

Food & lifestyle

• grapefruit juice

  Major

  Metabolism

  Coadministration with grapefruit juice may increase the plasma concentration of valbenazine. The mechanism is inhibition of CYP450 3A4-mediated first-metabolism in the gut wall by certain compounds present in grapefruits.

  What to do: Pharmacologic response to valbenazine should be monitored more closely whenever a strong inhibitor of CYP450 3A4 is added to or withdrawn from therapy. Assessment of baseline QT interval and periodic monitoring during therapy may be considered. The manufacturer recommends reducing the dose of valbenazine to 40 mg once daily during concomitant administration with strong CYP450 3A4 inhibitors. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope. In addition, patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  1 source

  1. "Product Information. Ingrezza (valbenazine)." Neurocrine Biosciences, Inc. (2017):

Conditions

Conditions in which Valbenazine Tosylate needs care, as documented in this source.

• Kidney Diseases

  Major

  The use of valbenazine is not recommended in patients with severe renal impairment (creatinine clearance <30 mL/min). Dosage adjustment is not necessary for patients with mild to moderate renal impairment (creatinine clearance 30 to 90 mL/min).

  1 source

  1. "Product Information. Ingrezza (valbenazine)." Neurocrine Biosciences, Inc. (2017):

• Liver Diseases

  Major

  Valbenazine is extensively metabolized after oral administration by the liver. Dosage adjustment of valbenazine 40 mg once daily is recommended for patients with moderate or severe hepatic impairment (Child-Pugh score 7 to 15). Close monitoring of hepatic function is recommended.

  1 source

  1. "Product Information. Ingrezza (valbenazine)." Neurocrine Biosciences, Inc. (2017):

• Long QT Syndrome

  Major

  Valbenazine may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. The use of valbenazine should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, it is recommended to assess the QT interval before increasing the dosage.

  1 source

  1. "Product Information. Ingrezza (valbenazine)." Neurocrine Biosciences, Inc. (2017):

• Parkinson Disease

  Moderate

  The use of vesicular monoamine transporter 2 (VMAT2) inhibitor, such as valbenazine and deutetrabenazine may cause parkinsonism in patients with tardive dyskinesia. These agents should be used with caution in patients with parkinson disease or those presenting with parkinson-like symptoms such as, falls, gait disturbances, tremor, drooling and hypokinesia. It is recommended to reduce the dose or to discontinue treatment in patients who develop clinically significant parkinson-like signs or symptoms while on treatment with these agents.

  2 sources

  1. "Product Information. Ingrezza (valbenazine)." Neurocrine Biosciences, Inc. (2017):
  2. "Product Information. Austedo (deutetrabenazine)." Teva Pharmaceuticals USA (2017):