VMAT2 Inhibitors in Tardive Dyskinesia

Prior to 2017, clinicians were limited to options such as vitamin E, amantadine, lowering antipsychotic doses, or switching antipsychotics, but evidence was minimal and results inconsistent. VMAT2 inhibitors introduced the first robust, randomized, placebo controlled data demonstrating meaningful symptom improvement. The panel emphasizes that these agents require a structured approach to dosing, titration, and monitoring. Clinicians must set expectations that noticeable improvement often requires several weeks, even though small changes may appear earlier on structured assessments. Effective treatment depends on collaboration across care settings, including communication between outpatient clinics, pharmacies, and mental health centers to relay AIMS findings, monitor patient tolerability, adjust doses, and identify side effects or drug interactions. VMAT2 inhibitors are positioned as first line therapy because they offer the strongest evidence base and a clear, systematic pathway for symptom reduction.