Ingrezza (Valbenazine): Uses, How it Works, Dosage, Side Effects, and More

Ingrezza (pronounced in-GREH-zah) is an oral prescription medication used in adults to manage certain body movement disorders. Its generic name is valbenazine (pronounced val-BEN-a-zeen). It is available as regular capsules to be swallowed whole and as sprinkle capsules that can be opened and mixed with soft food. 

Ingrezza belongs to the drug class of VMAT2 inhibitors (vesicular monoamine transporter-2 inhibitors) that reduce unwanted or uncontrolled movements. 

The FDA first approved Ingrezza in 2017 for tardive dyskinesia (TD) in adults, and in 2023, it received approval for the treatment of chorea associated with Huntington’s disease. 

Today, this medication is a widely used treatment for people living with movement disorders. This article covers everything you need to know about this drug, including how it works, how to take it, optimal dosage, possible side effects, and important safety information. 

Indications (Approved Uses)

Ingrezza is approved to treat two main conditions in adults, which include:

Tardive Dyskinesia (TD)

Tardive dyskinesia is a nervous system disorder that causes involuntary, uncontrolled muscle movements in the face, tongue, or other body parts. These movements can look like lip-smacking, jaw clenching, tongue rolling, grimacing, twitching, or jerking. 

TD usually develops after the chronic use of antipsychotic medications. 

Chorea From Huntington’s Disease 

Similar to tardive dyskinesia, chorea is another movement disorder that causes sudden, irregular, dance-like, or fidgety movements that a person cannot control. These movements are more common in people with Huntington’s disease (a genetic condition that affects nerve cells in the brain). 

Ingrezza (valbenazine) controls the frequency and severity of uncontrolled movements in patients with tardive dyskinesia and chorea. However, it does not cure these conditions. 

Important Safety Information (Boxed Warning)

Ingrezza may cause serious side effects, including depression and suicidal thoughts or actions. Tell your doctor if you have depression or a history of suicidal thoughts before starting the medication.

Mechanism of Action

Generally, your brain uses a chemical messenger called dopamine to control movement. But when an individual uses antipsychotic drugs chronically, it causes abnormal dopamine signaling in the brain.

Excessive dopamine release leads to repetitive, uncontrollable body movements. Ingrezza helps to reduce the excessive dopamine activity and decrease the involuntary movements seen in TD and chorea. 

Working Mechanism

Valbenazine, the active molecule in Ingrezza, is a vesicular monoamine transporter-2 (VMAT2) inhibitor that selectively and specifically targets VMAT2, a protein that helps regulate the release of dopamine in the brain. 

By blocking the VMAT2 protein, Ingrezza corrects the abnormal dopamine signaling, which results in smoother, more controlled body movements over time. 

Drug Form

Ingrezza comes in two oral forms:

• Standard capsules that you swallow
• Sprinkle capsules that may be opened and mixed with soft food for people who have trouble swallowing pills.

Both Ingrezza and Ingrezza Sprinkle capsules come in strengths of 40 mg, 60 mg, and 80 mg.

Recommended Dosage and Administration

1. Recommended Dosage

The FDA-recommended dosage for patients with tardive dyskinesia and Huntington’s chorea is as follows:

• For Tardive Dyskinesia (TD): The initial dose is 40 mg once a day. After 1 week, increase the dose to the recommended 80 mg once daily.
• For Huntington’s Chorea: The starting dose is 40 mg once daily, with the dose increased by 20 mg every two weeks until reaching the recommended dose of 80 mg once daily. 

Depending on your response and tolerability to Ingrezza, a dosage of 40 mg or 60 mg once daily may be considered. 

2. Administration Information

Ingrezza capsules and Ingrezza Sprinkle capsules are taken orally once a day, with or without food. 

If you take the capsules, swallow the whole capsule with water. Do not crush or chew. 

If you take Sprinkle capsules:

• You may open the capsule and sprinkle the contents (granules) over a small amount (1 tablespoonful) of soft food such as applesauce, yogurt, or pudding. 
• Swallow the soft food without chewing, and drink a glass of water to make sure all of the medicine is swallowed.
• You may also swallow the Sprinkle capsule whole with water. 
• Do not add the granules to milk or water.

Possible Side Effects of Ingrezza

Ingrezza capsule and Ingrezza Sprinkle may cause mild or potentially serious side effects. If you experience any of these, consult your healthcare provider.

Mild Side Effects

Some of the mild side effects that you may experience during treatment include:

• Headache
• Tiredness and sleepiness (most commonly seen in TD and chorea)
• Hives (raised itchy red areas) or rash (most commonly seen in people with chorea)
• Insomnia (most commonly seen in people with chorea)
• Problems with balance or coordination
• Dry mouth
• Restlessness
• Constipation
• Blurred vision
• Weight gain
• Nausea or vomiting 

In most cases, these side effects are temporary, and some can be easily managed. But if you have ongoing symptoms that bother you, talk to your doctor. 

Adverse Effects

Though rare, Ingrezza can also cause adverse effects. Some of the serious side effects that have been reported include:

• Depression and suicidal thoughts: Mostly seen in patients with Huntington’s disease.
• Severe allergic reactions: Allergic reactions include trouble breathing or shortness of breath; swelling of your face, lips, eyelids, tongue, or throat, or other areas of your skin; trouble with swallowing; rash; or hives.
• Neuroleptic malignant syndrome (NMS): This is a serious condition that can lead to death. Symptoms include stiff muscles, irregular pulse or blood pressure, increased sweating, high fever, or a very fast or uneven heartbeat. 
• Heart rhythm problems (QT prolongation): This happens when you take other medicines with Ingrezza. Symptoms may include fast, slow, or uneven heartbeats, lightheadedness, fainting, or shortness of breath.
• Parkinson’s-like symptoms: This includes tremors, shaking, stiffness, problems with balance or walking.

Your doctor may change your dose, temporarily stop, or permanently stop treatment with Ingrezza if you develop any of the above adverse effects. 

Precautionary Measures 

Before Taking this Medicine

Before taking Ingrezza (valbenazine), tell your doctor if you:

• Have emotional or mental problems (i.e., depression, nervousness, anxiety, anger, agitation, psychosis, previous suicidal thoughts or suicide attempts) 
• Have liver problems
• Have heart disease that is not stable, have heart failure, or have recently had a heart attack
• Have an irregular heart rhythm or heartbeat (e.g., QT prolongation, heart arrhythmia)
• Are pregnant or plan to become pregnant (Ingrezza may harm your unborn baby)
• Are breastfeeding or plan to breastfeed. It is not known if Ingrezza passes into your breast milk. Do not breastfeed during treatment and for 5 days after the final dose
• Are taking any prescription (e.g., monoamine oxidase inhibitors (MAOI) or digoxin) or over-the-counter medicines, vitamins, and herbal supplements

After Taking This Medicine

Ingrezza is reported to cause slow reaction times (somnolence/sedation). Therefore, it is recommended to avoid driving, operating heavy machinery, or engaging in any potentially dangerous activities until you know how the drug affects you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Moreover, avoid taking alcohol or other medicines that can cause sleepiness during treatment. 

Medicines To Avoid While Taking Ingrezza 

You should not take monoamine oxidase inhibitors (MAOIs) with Ingrezza, as these medicines can increase side effects and decrease the effectiveness of Ingrezza. 

Below is the list of drugs that you should avoid taking during your treatment with Ingrezza:

• MAOIs include phenelzine, tranylcypromine, isocarboxazid, and selegiline
• Antidepressants like paroxetine or fluoxetine 
• Antifungal medications, itraconazole and ketoconazole, and antibiotics like clarithromycin
• Certain seizure medications, such as carbamazepine or phenytoin
• Antibiotic rifampin
• Herbal supplements containing St. John’s wort

Moreover, taking Ingrezza with antipsychotics, tricyclic antidepressants, heart medications, and antibiotics may increase the risk of developing irregular heart rhythms.

Ingrezza Cost

Ingrezza can be expensive for people paying out-of-pocket since it’s a branded drug and is not available in a generic version. However, if you’re new to this drug, you can get a 1-month supply of Ingrezza free of cost through an Ingrezza 30-day free trial program. 

The estimated cost of Ingrezza and Ingrezza Sprinkle (valbenazine) capsules may vary depending on several factors, such as your dosage, what your insurance plan covers, and the type of specialty pharmacy you use. 

The average wholesale price for 30 capsules of Ingrezza (a one-month supply for most patients) is $5,750 for the 40-mg strength and $6,225 for the 80-mg strength. 

On the other hand, if you have commercial (non-government) insurance, you may qualify for a $0 copay through the Ingrezza Savings Card offered by the INBRACE Support Program. Most patients with this type of insurance pay $10 or less per month for their prescription.If you are interested in exploring financial assistance opportunities for Ingrezza, get in touch with one of our specialists for assistance.