New Review on VMAT2 Inhibitors and Ingrezza for Treatment of Tardive Dyskinesia

Neurocrine Biosciences has announced publication of a narrative review paper on US Food and Drug Administration (FDA) approved vesicular monoamine transporter 2 (VMAT2) inhibitors Ingrezza (valbenazine) and deutetrabenazine.¹ The review covers clinical research on these drugs for treatment of tardive dyskinesia and highlights the unique profile of Ingrezza.

The paper reviews differences between Ingrezza and deutetrabenazine, emphasizing the distinct pharmacologic, dosing, and clinical profiles of the 2 drugs. With data from previous studies, the review presents results from double-blind, placebo-controlled clinical trials, post-hoc analyses, and long-term studies for both VMAT2 inhibitors. Ingrezza was noted to have unique attributes of selectivity to VMAT2, demonstrated therapeutic response at 40 mg (the lowest available dose), and data collected across a range of patient populations.²

Ingrezza and deutetrabenazine were noted to have key differences. Both medications target VMAT2 receptors, but Ingrezza was found to work with a single metabolite with high affinity for VMAT2 and had no off-target receptor activity.² The review considered different dosing and formulation availabilities for the different drugs, as well as considerations for concomitant medications and special populations taking this medication. Post-hoc and clinical trial results were included in the review, providing context and background for both medication options. Ingrezza was highlighted as having extensive clinical development with diverse patient populations. Long-term study findings included clinically meaningful and sustained efficacy, along with consistent tolerability profile over time and across studies. The review also included a supplemetal guide on VMAT2 inhibitors, sharing further data on pharmacokinetics, dosing considerations, drug interactions, and clinical findings.

"This inclusive resource will help inform healthcare providers to further understand the differences between the two available VMAT2 inhibitors for tardive dyskinesia, with the goal of supporting optimal treatment decisions for each patient," Sanjay Keswani, MD, chief medical officer of Neurocrine Biosciences, said in a press release. "The review findings highlight how these distinctions can carry meaningful clinical implications for drug selection, emphasizing that appropriate treatment depends on understanding each medication's unique mechanism, safety profile and dosing requirements. Notably, this includes the distinctive profile of Ingrezza with no-titration dosing and comprehensive clinical evidence," Keswani added.

Ingrezza is a selective VMAT2 inhibitor and is currently approved by the FDA for treatment of tardive dyskinesia and chorea associated with Huntingon disease in adults. The drug has been shown to inhibit only VMAT2, with no affinity for VMAT1, dopaminergic, serotonergic, adrenergic, histaminergic, or muscarinic receptors. Inhibition of VMAT2 is thought to inhibit dopamine release, affecting movement control. With inhibited dopamine release, Ingrezza is believed to reduce excessive dopamine signaling, leading to fewer uncontrollable movements for the patient. The medication is taken once daily and can be taken along with most antipsychotics and antidepressants. Ingrezza also has a sprinkle formulation, which can be useful for patients experiencing dysphagia, difficulty swallowing, or a preference for non-pill medication forms. Approved dosages include 40 mg, 60 mg, and 80 mg.

References

1. Neurocrine Biosciences announces publication of landmark narrative review on FDA-approved VMAT2 inhibitors demonstrating unique profile of Ingrezza (valbenazine) capsules. Press release. November 20, 2025. Accessed November 20, 2025. https://www.prnewswire.com/news-releases/neurocrine-biosciences-announces-publication-of-landmark-narrative-review-on-fda-approved-vmat2-inhibitors-demonstrating-unique-profile-of-ingrezza-valbenazine-capsules-302620990.html

2. Patel AR, Hauser RA, Citrome L, et al. VMAT2 inhibitors for the treatment of tardive dyskinesia: a narrative review. CNS Spectrums. 2025;30(1):e90.