Dopamine depleters in the treatment of hyperkinetic movement disorders.
Abnormal involuntary movements often improve in response to anti-dopaminergic drugs. In contrast to classic neuroleptics that block dopamine receptors, drugs that deplete presynaptic dopamine by blocking vesicular monoamine transporter type 2 (VMAT2) seem to be safer and have little or no risk of tardive dyskinesia. This is one reason why there has been a recent emergence of novel VMAT2 inhibitors. Areas covered: Since the approval of tetrabenazine, the classic VMAT2 inhibitor, in the treatment of chorea associated with Huntington disease (HD), other VMAT2 inhibitors (e.g. deutetrabenazine and valbenazine) have been studied in the treatment of HD-related chorea, tardive dyskinesia and tics associated with Tourette syndrome. This review, based largely on a detailed search of PubMed, will summarize the pharmacology and clinical experience with the various VMAT2 inhibitors. Expert commentary: Because of differences in pharmacology and pharmacokinetics these new VMAT2 inhibitors promise to be at least as effective as tetrabenazine but with a lower risk of adverse effects, such as sedation, insomnia, depression, parkinsonism, and akathisia.
a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA.
Joseph
J
Jankovic
D000818:Animals; D014150:Antipsychotic Agents / Q000627:therapeutic use; D004298:Dopamine / Q000378:metabolism*; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D006816:Huntington Disease / Q000188:drug therapy / Q000378:metabolism; D006948:Hyperkinesis / Q000188:drug therapy* / Q000378:metabolism*; D009069:Movement Disorders / Q000188:drug therapy* / Q000378:metabolism*; D011954:Receptors, Dopamine / Q000378:metabolism; D000071057:Tardive Dyskinesia / Q000188:drug therapy / Q000378:metabolism; D013747:Tetrabenazine / Q000627:therapeutic use; D020323:Tics / Q000188:drug therapy / Q000378:metabolism; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D011954:Receptors, Dopamine; D004298:Dopamine; D013747:Tetrabenazine
Deutetrabenazine; Huntington disease; Tourette syndrome; VMAT2; chorea; dopamine; hyperkinetic movements; orphan drug; tardive dyskinesia; tetrabenazine; valbenazine; vesicular monoamine transporter