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Home | About | Xenazine Side Effects

Xenazine® (tetrabenazine) Side Effects

Before You Start Xenazine

Before you or a loved one starts taking Xenazine, tell your doctor about all of the prescription medications — as well as non-prescription medicines, vitamins, herbal products or other supplements — that you or your loved one are taking. Xenazine may interact with some of these medications. Make sure you tell your doctor before you start or stop any new medication or if you change the dose of any medication or supplements you are taking.

Xenazine can be taken along with an antidepressant, but your depression must be under control. Patients with depression were allowed into the Xenazine clinical trial only if their depression was under control and over half had a history of depression.2

Xenazine can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease.2 You should tell your doctor if you are depressed before you start taking Xenazine. You should not start taking Xenazine if you are depressed or have suicidal thoughts.

Always read the Medication Guide before starting your treatment with Xenazine and every time your prescription is refilled, as the information may have changed. If you have any questions regarding Xenazine, be sure to talk with your doctor.

We had concerns with starting Xenazine. We knew there was an increased risk for depression and suicide. So, we spoke to our doctor in-depth about the side effects. When we reviewed the risks and weighed those against the benefits, we decided to go ahead and start taking Xenazine.”
~ Sami, caregiver of person living with HD

Can Side Effects Be Managed?


Sue and Jeff’s Story

Sue and Jeff share their experiences living with Huntington’s disease, from their initial reactions to her diagnosis to working with their doctor to find treatment for her HD chorea symptoms.

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Chorea Symptoms in Huntington's Disease

Dr. Sung discusses how chorea can affect Huntington's disease patients.

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Craig and Sara's Huntington's Disease Story

Watch Craig and Sara discuss their experiences with chorea associated with Huntington's disease and how it can affect the entire family.

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Matt’s HD Chorea

See how Matt and his caregiver and wife, Karen, worked to find treatment options, including Xenazine, to help manage his HD chorea.

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Medication Assistance Program: REACH

Learn about Lundbeck’s medication assistance program, REACH, which offers financial assistance for Xenazine patients who qualify.

Discover what REACH might do for you »

HD Chorea Symptoms: Improvement Since Xenazine

Listen as these caregivers share their individual stories on how Xenazine helped with chorea symptoms associated with Huntington’s disease.

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Side effects with Xenazine occur most often when the medication is first started or when the dose is increased. If you or your loved one begins taking Xenazine and starts to experience a side effect, you should tell your doctor right away. Your doctor may decide to:

  • Lower your dose of Xenazine to see if the side effect lessens or goes away
  • Prescribe a medication to reduce the side effect
  • Discontinue Xenazine, if the side effect cannot be managed

The goal of Xenazine therapy is to reduce HD chorea while managing side effects. Your doctor has many options to help you manage side effects so that you will be able to get the most from your Xenazine therapy.

The need for therapy should be evaluated on an ongoing basis with your doctor. The dose of Xenazine should be adjusted slowly over several weeks for a dose that is appropriate for you. Tell your doctor if you stop taking Xenazine for more than 5 days. Do not take another dose until you talk to your doctor. If your doctor thinks you need to take more than 50 mg of Xenazine each day, you will need to have a blood test to see if a higher dose is right for you.

Some people should not take Xenazine. Xenazine can increase the chance of depression, suicidal thoughts or suicidal actions in some patients.

Do not take Xenazine if:

  • You are sad (depressed) much of the time. You can become more depressed taking Xenazine.
  • You take medicine for depression, but it is not well controlled.
  • You think or talk about harming yourself or killing yourself (suicide). You may be more likely to think about ending your life while taking Xenazine.
  • You have liver problems.
  • You take a monoamine oxidase inhibitor (MAOI), reserpine or a medicine that contains reserpine. If your doctor plans to switch you from taking reserpine to Xenazine, you must wait at least 20 days after your last dose of reserpine before you start taking Xenazine. Ask your doctor or pharmacist if you are not sure.

When taking Xenazine, pay close attention to any changes in how you feel. Let your doctor know if you have sudden changes in your mood, behaviors or thoughts. These changes may occur when you start Xenazine and when your doctor changes your dose.

Possible Xenazine side effects

Xenazine can cause serious side effects, including:

  • Depression, suicidal thoughts or actions. See: “What is the most important information I should know about Xenazine?
  • Neuroleptic malignant syndrome (NMS). Call your doctor right away and go to the nearest emergency room if you develop these signs and symptoms that do not have another obvious cause:
    • High fever
    • Stiff muscles
    • Problems thinking
    • Very fast or uneven heartbeat
    • Increased sweating
  • Parkinsonism. Symptoms of parkinsonism include: slight shaking, body stiffness, trouble moving or keeping your balance.
  • Restlessness. You may get a condition where you feel a strong urge to move. This is called akathisia.
  • Trouble swallowing. Xenazine may increase the chance that you will have trouble swallowing. Increased coughing may be the first sign that you are having trouble swallowing. Trouble swallowing increases your risk of pneumonia.
  • Irregular heartbeat. Xenazine increases your chance of having certain changes in the electrical activity in your heart which can be seen on an electrocardiogram (EKG). These changes can lead to a dangerous abnormal heartbeat. Taking Xenazine with certain medicines may increase this chance.
  • Dizziness due to blood pressure changes when you change position (orthostatic hypotension). Change positions slowly from lying down to sitting up and from sitting up to standing when taking Xenazine. Tell your doctor right away if you get dizzy or faint while taking Xenazine. Your doctor may need to watch your blood pressure closely.
  • Tardive dyskinesia (TD). TD is a condition where there is repeated facial grimacing that cannot be controlled, sticking out of the tongue, smacking of the lips, puckering and pursing of the lips, and rapid eye blinking. Xenazine works like other drugs that can cause TD. If you get TD with Xenazine, it is possible that the TD will not go away.

Common side effects

Common side effects with Xenazine include:

  • Sleepiness (sedation)
  • Tiredness
  • Trouble sleeping
  • Depression
  • Anxiety
  • Restlessness
  • Agitation
  • Nausea

Tell your doctor if you have any side effects. Do not stop taking Xenazine without talking to your doctor first.

Call your doctor for medical advice about side effects. You may also report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088.

XENAZINE® (tetrabenazine) Tablets

Indications and Usage:

XENAZINE is a medicine that is used to treat the involuntary movements (chorea) of Huntington's disease. XENAZINE does not cure the cause of the involuntary movements, and it does not treat other symptoms of Huntington's disease, such as problems with thinking or emotions.

It is not known whether XENAZINE is safe and effective in children.

Important Safety Information:

  • XENAZINE can cause serious side effects, including:
    • depression
    • suicidal thoughts
    • suicidal actions
  • You should not start taking XENAZINE if you are depressed (have untreated depression or depression that is not well controlled by medicine) or have suicidal thoughts.
  • Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts or feelings, or worsening depression. This is especially important when XENAZINE is started and when the dose is changed.
  • Do not take XENAZINE if you have liver problems or are taking monoamine oxidase inhibitors (MAOIs) or reserpine. Ask your doctor or pharmacist if you are not sure. At least 20 days should pass after stopping reserpine before starting XENAZINE.
  • Tell your doctor if you are pregnant or plan to become pregnant, breast-feeding, have breast cancer or a history of breast cancer, or have heart disease or an irregular heartbeat.
  • Tell your doctor about all the medicines you take. Do not start any new medicines while taking XENAZINE without talking to your doctor first.
  • Take XENAZINE exactly as prescribed by your doctor. The need for therapy should be evaluated on an ongoing basis with your doctor. The dose of XENAZINE should be adjusted slowly over several weeks for a dose that is appropriate for you. Tell your doctor if you stop taking XENAZINE for more than 5 days. Do not take another dose until you talk to your doctor. If your doctor thinks you need to take more than 50 mg of XENAZINE each day, you will need to have a blood test to see if a higher dose is right for you.
  • Neuroleptic Malignant Syndrome (NMS) is a potentially fatal side effect reported with XENAZINE. Call your doctor right away and go to the nearest emergency room if you develop these signs and symptoms that do not have another obvious cause: high fever, stiff muscles, problems thinking, very fast or uneven heartbeat, or increased sweating. XENAZINE should be stopped immediately if NMS is diagnosed.
  • XENAZINE can also cause other serious side effects, including: parkinsonism (slight shaking, body stiffness, trouble moving, or keeping your balance), restlessness (akathisia), trouble swallowing, irregular heartbeat, and dizziness due to blood pressure changes when you change position (orthostatic hypotension). Trouble swallowing may increase the risk of pneumonia. Uncontrolled movements called tardive dyskinesia (TD) may also develop in patients treated with XENAZINE. It is possible that the TD will not go away.
  • The risk of side effects, such as irregular heartbeat, parkinsonism, NMS, and restlessness (akathisia), may be increased when using XENAZINE with other drugs (e.g., dopamine antagonists or antipsychotics).
  • Sleepiness is a common side effect of XENAZINE; do not drive a car or operate dangerous machinery until you know how XENAZINE affects you. Alcohol and other drugs may increase sleepiness caused by XENAZINE.
  • Some side effects, such as depression, tiredness, trouble sleeping, sleepiness, parkinsonism, agitation, and restlessness (akathisia), may be dose-dependent. If the side effects don’t stop or lessen, your doctor should consider lowering the dose or stopping your XENAZINE. The most commonly reported side effects in studies with XENAZINE were sleepiness, trouble sleeping, depression, tiredness, anxiety, restlessness, agitation, and nausea.

For more information, please see the full Prescribing Information, including Boxed Warning, the Medication Guide or go to www.XenazineUSA.com.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Sources:

  1. "FDA Approves First Drug for Treatment of Chorea in Huntington's Disease", FDA News Release, August 15, 2008: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116936.htm. Updated April 15, 2013. Accessed August 17, 2015.
  2. Huntington Study Group. Tetrabenazine as antichorea therapy in Huntington disease: a randomized controlled trial. Neurology. 2006;66(3):366-372.