eCase: Use of Valbenazine in an Older Patient With Tardive Dyskinesia

Discussion

This case study described the successful use of a VMAT2 inhibitor in an older patient with TD who had poor insight into her TD symptoms and orofacial hyperkinesis in response to lurasidone that was worsened with pramipexole. Despite her long history of bipolar disorder, older age, and atypical antipsychotic exposure, when she developed orofacial dyskinesis after initiation of lurasidone, it was misdiagnosed as drug-induced parkinsonism and treated with discontinuation of lurasidone and initiation of pramipexole, which worsened her orofacial dyskinesis. Despite the patient’s poor insight into her TD symptoms that progressed to mouth sores and orofacial muscular stiffness and started to affect her social functioning, diagnosis, and treatment were ultimately facilitated through regular follow-ups, in-person evaluation, formal AIMS assessment, patient interviews to increase symptom awareness, and discussions about available treatments. The selective VMAT2 inhibitor valbenazine was chosen due to it once-daily dosage best suited to ensure patient adherence. Valbenazine treatment resulted in improvement of TD symptoms without noticeable adverse events.