Julie Dopheide, PharmD, BCPP, FASHP

Panelists discuss how comprehensive educational resources are essential for empowering patients with TD to better understand their condition, actively participate in their treatment decisions, and achieve optimal outcomes through improved self-management and adherence.

Panelists discuss how pharmacists employ multiple strategies to support medication adherence in older adults with TD, including simplifying dosing regimens, utilizing medication synchronization programs, providing medication packaging solutions, conducting regular follow-up calls, and collaborating closely with prescribers and care teams to develop and adjust personalized treatment plans that address individual patient needs and barriers to care.

Panelists discuss how pharmacists must carefully consider factors like age-related changes in drug metabolism, comorbid conditions, concurrent medications, fall risk, and individual patient response when dosing and titrating VMAT2 inhibitors in older adults, typically recommending a "start low, go slow" approach while closely monitoring for both efficacy and adverse effects.

Panelists discuss how pharmacists serve as essential medication experts by providing comprehensive counseling on VMAT2 inhibitors, including proper administration, expectations for symptom improvement, potential side effects, and drug interactions, while playing a vital role in monitoring older adult patients through regular check-ins, medication therapy management services, and collaboration with the healthcare team to optimize treatment outcomes.

Panelists discuss how the TD patient journey often begins with subtle symptoms that may go unrecognized, particularly in older adults who face unique challenges with diagnosis and treatment, while emphasizing the crucial role pharmacists play in early identification through medication reviews, regular monitoring of patients on antipsychotics, coordination with healthcare providers, and ongoing assessment of treatment response and adherence.

Panelists discuss how barriers to optimizing TD therapy include insurance coverage limitations, high medication costs, delayed diagnosis, lack of provider awareness, and stigma associated with movement disorders, while highlighting strategies like patient assistance programs, early screening protocols, provider education initiatives, and collaborative care models to overcome these obstacles and improve access to effective treatment.

Panelists discuss how TD treatment can be optimized through individualized approaches that consider patient-specific factors like symptom severity, comorbidities, concurrent medications, and daily routines, utilizing tools like titration kits to carefully adjust VMAT2 inhibitor dosing while monitoring response and tolerability to achieve the best possible outcomes for each patient.

Panelists discuss how managing tardive dyskinesia in patients with comorbid mental health conditions requires a delicate balance between treating TD symptoms while maintaining psychiatric stability, emphasizing the importance of coordinated care between psychiatrists and movement disorder specialists to optimize medication regimens, monitor for potential drug interactions, and address the complex interplay between physical symptoms and psychological well-being.

Panelists discuss how VMAT2 inhibitors' most commonly reported adverse effects include somnolence, fatigue, and mild parkinsonism symptoms, which can typically be managed through dose adjustments and careful titration strategies, while noting these side effects are generally less severe than those of older treatments and rarely lead to discontinuation when patients are properly monitored and educated about expectations.

Panelists discuss how long-term open-label extension studies of VMAT2 inhibitors demonstrated sustained efficacy and tolerability of both deutetrabenazine (ARM-TD and AIM-TD extensions showing durable response over 3 years) and valbenazine (KINECT 4 showing maintained improvements through 48 weeks), with low discontinuation rates due to adverse events and no new safety signals emerging during extended treatment periods.

Panelists discuss how VMAT2 inhibitors deutetrabenazine and valbenazine have revolutionized TD treatment through their proven efficacy in reducing involuntary movements and favorable safety profiles, with clinical trials demonstrating significant symptom improvement as measured by AIMS scores while maintaining psychiatric stability and showing key differences in dosing schedules and titration approaches.

Panelists discuss how comprehensive patient education about tardive dyskinesia risk factors, early warning signs, and available treatments is crucial for improving outcomes, while highlighting remaining unmet needs including better screening tools, enhanced provider training, expanded access to VMAT2 inhibitors, and more research into prevention strategies and novel therapeutic approaches.

Panelists discuss how untreated tardive dyskinesia severely impacts patients' daily functioning and quality of life through physical limitations affecting basic tasks like eating and walking, social isolation due to visible symptoms, and heightened risks for older adults who face increased fall risks, difficulty maintaining independence, and complications from age-related comorbidities.

Panelists discuss how clinicians rely on careful observation, standardized rating scales like the AIMS (Abnormal Involuntary Movement Scale), and comprehensive patient histories to diagnose tardive dyskinesia, while facing challenges in distinguishing it from other movement disorders due to symptom overlap and the need to rule out conditions like drug-induced parkinsonism, akathisia, and primary movement disorders.