Valbenazine

INGREZZA

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Pronunciation: val-BEN-a-zeen (in-GRE-za)

Valbenazine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Valbenazine ballicule

Valbenazine INGREZZA mascot mnemonic cartoon — Visual mnemonic: Valbenazine mascot
**“Valved bin In grease”**
QT prolongation

What it isReversible VMAT2 inhibitor that reduces presynaptic dopamine packaging; tardive dyskinesia.

Why this oneIt usually needs less titration than deutetrabenazine and lets the causative antipsychotic continue.

What limits itSomnolence and QT prolongation; CYP2D6 or CYP3A4 inhibition raises exposure.

Valbenazine molecular structure (skeletal formula) — Molecular structure: Valbenazine

FDA-approved for

tardive dyskinesia (2017)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Increases risk of depression and suicidal ideation/behavior in patients with Huntington's disease.

FDA dosing	Population	Start	Target	Max
Tardive dyskinesia	Adults	40 mg QD	80 mg QD (after 1 wk); 40–60 mg QD per response	80 mg QD
Chorea associated with Huntington's disease	Adults	40 mg QD	80 mg QD (↑20 mg q2wk); 40–60 mg QD per response	80 mg QD

Titration Tardive dyskinesia: increase after 1 week. Huntington's chorea: increase in 20 mg increments every 2 weeks.

Renal Undefined

Hepatic Moderate or severe hepatic impairment: 40 mg QD.

Instructions

With or without food
Sprinkle: empty capsule over ~1 tbsp soft food (not milk/water), swallow immediately, or swallow capsule whole; do not crush/chew; do not give via enteral tubes
Known CYP2D6 poor metabolizers: 40 mg QD

Available strengths

cap 40, 60, 80 mg

Cautions

QT prolongation (avoid in congenital long QT or QT-prolonging arrhythmias)
Somnolence/sedation (impaired driving)
Neuroleptic malignant syndrome
Parkinsonism
Hypersensitivity/angioedema

Adverse reactions

Somnolence/sedation
Urticaria, rash (Huntington's chorea)
Insomnia (Huntington's chorea)

Pregnancy Insufficient human data; animal data show increased stillbirths/pup mortality — may cause fetal harm.

Lactation Do not breastfeed during treatment and for 5 days after the final dose.

Cost

Valbenazine (INGREZZA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	brand $/mo	CostPlus
40 mg	cap	30 qd	—	$7,768.25	not offered
60 mg	cap	30 qd	—	$8,499.72	not offered
80 mg	cap	30 qd	—	$8,499.72	not offered

Generic entry2038 (settlement)

⚠ BOXED WARNING

Depression and suicidality in Huntington disease

Principal riskSomnolence and QT prolongation

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.

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Memory aids: interaction avatars

CYP2D6 substrate

CYP3A4 substrate

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