Treatment Selection and Dosing in Tardive Dyskinesia

In this episode, the panel discusses key considerations for selecting and dosing VMAT2 inhibitors in tardive dyskinesia. They note that understanding TD remains incomplete, with ongoing research into mechanisms involving GABA, glutamate, and genetic polymorphisms, which influences how clinicians approach treatment selection. When focusing on dosing, the panel emphasizes setting realistic expectations for patients. VMAT2 inhibitors are effective, but symptom improvement typically requires one to two months as doses are titrated to an individualized therapeutic level. Clinicians should prepare patients for potential side effects, particularly sedation, which is the most common, as well as headache. Urinary tract infections were reported in clinical trials, though not frequently observed in practice. The panel stresses the importance of monitoring tolerability, adjusting doses gradually, and encouraging patients to report side effects so dosing can be optimized safely.