Xenazine is a brand-name prescription medication. It’s approved to treat chorea that’s associated with Huntington’s disease in adults.
With chorea, you have uncontrollable movements of the legs, arms, and facial muscles. Chorea may be caused by Huntington’s disease (a genetic condition that affects your brain).
Xenazine contains the active drug tetrabenazine. It belongs to a drug class called vesicular monoamine transporter 2 (VMAT2) inhibitors.
Xenazine comes as an oral tablet. It’s available in two strengths: 12.5 milligrams (mg) and 25 mg.
For information about the effectiveness of Xenazine, see the “Xenazine uses” section below.
Xenazine is a brand-name drug that contains the active drug tetrabenazine. This active drug is also available as a generic medication. A generic drug is an exact copy of the active drug in a brand-name medication.
The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.
If you’re interested in using the generic form of Xenazine, talk with your doctor. They can tell you if it comes in forms and strengths that can be used for your condition.
The Xenazine dosage your doctor prescribes will depend on several factors. These include:
- the severity of the condition you’re using Xenazine to treat
- how your body responds to Xenazine treatment
- other medications you may take
Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Xenazine comes as an oral tablet.
Drug strengths: 12.5 mg, 25 mg
Xenazine comes in two strengths: 12.5 milligrams (mg) and 25 mg.
Dosage for uncontrollable movements associated with Huntington’s disease
For uncontrollable movements associated with Huntington’s disease, the recommended starting dosage of Xenazine is 12.5 mg taken once per day in the morning. After 1 week, your doctor will likely increase your dosage to 12.5 mg twice per day. Then your doctor may continue to increase your dosage at weekly intervals. Depending on how your body responds to the drug, they’ll adjust your dosage until they find the amount that’s right for you.
If you develop bothersome side effects after a dose increase, your doctor may lower your dosage. They may also recommend other treatments to help manage the side effects so that you can continue Xenazine treatment.
Due to genetic differences between individuals, the dosage of Xenazine may need to be adjusted. Before your doctor increases your dose to more than 50 mg of Xenazine per day, they’ll have you get a genetic test. This test will check your body’s ability to metabolize (break down) certain drugs, including Xenazine. The test results will help your doctor determine a safe maximum dosage for you.
The maximum dosage of Xenazine ranges from 50 mg to 100 mg per day. If your doctor prescribes a total daily dose of 37.5 mg or higher, you’ll likely take the drug in three divided doses throughout the day.
What if I miss a dose?
Before starting Xenazine, talk with your doctor about what steps to take if you miss a dose. If you miss a dose and it’s time for your next dose, do not take a double dose.
The symptoms of chorea (uncontrollable movements of the legs, arms, and facial muscles) associated with Huntington’s disease may return or get worse within 12 to 18 hours of when you took your last dose of Xenazine. (Xenazine is used to treat chorea that’s caused by Huntington’s disease.)
If you miss more than 5 consecutive days of Xenazine treatment, you should not take a dose until you talk with your doctor. They may need to have you restart the drug at a low dose and then slowly increase your dosage over time.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.
Will I need to use this drug long term?
Xenazine is meant to be a long-term treatment. If you and your doctor determine that Xenazine is safe and effective for you, you’ll likely take it long term.
As with all medications, the cost of Xenazine can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.
Keep in mind that you may be able to get a 90-day supply of Xenazine. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor, pharmacist, or insurance company.
Before approving coverage for Xenazine, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.
If you’re not sure if you’ll need to get prior authorization for Xenazine, contact your insurance company.
Financial and insurance assistance
If you need financial support to pay for Xenazine, or if you need help understanding your insurance coverage, help is available.
A program called Xenazine Copay Assistance Program is available for Xenazine. For more information and to find out if you’re eligible for support, call 888-882-6013 or visit the program website.
To learn more about saving money on prescriptions, check out this article.
Xenazine may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.
If your doctor recommends it, you may be able to receive a 90-day supply of Xenazine, so there’s less concern about running out of the medication. If you’re interested in this option, check with your doctor, pharmacist, or insurance company. Some Medicare plans may help cover the cost of mail-order medications.
If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.
Xenazine is available in a generic form called tetrabenazine. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs. To find out how the cost of tetrabenazine compares to the cost of Xenazine, talk with your doctor or pharmacist.
If your doctor has prescribed Xenazine and you’re interested in taking tetrabenazine instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.
Xenazine can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Xenazine. These lists do not include all possible side effects.
For more information about the possible side effects of Xenazine, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.
Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Xenazine, you can do so through MedWatch.
Mild side effects
Below is a partial list of mild side effects of Xenazine. To learn about other mild side effects, talk with your doctor or pharmacist, or view Xenazine’s prescribing information.
Mild side effects of Xenazine can include:
- akathisia (feeling restless and not being able to stay still)
- agitation (feeling irritated)
- mild allergic reaction*
Most of these side effects may go away within a few days to a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.
* For more information about allergic reaction and Xenazine, see “Allergic reaction” below.
Serious side effects
Serious side effects from Xenazine aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Serious side effects and their symptoms can include:
- Anxiety. Symptoms can include:
- not being able to stop worrying
- persistent nervousness
- trouble concentrating
- difficulty relaxing or sleeping
- Neuroleptic malignant syndrome (NMS), a group of symptoms that can be a side effect of drugs that work in the brain. Symptoms can include:
- high body temperature
- rigid muscles
- changes in blood pressure or heart rate
- Parkinsonism. Symptoms can include:
- moving more slowly than usual
- muscle stiffness
- Long QT syndrome (a change in the heart’s electrical signaling). Symptoms can include:
- feeling faint or fainting
- Orthostatic hypotension (a type of low blood pressure that occurs when standing after sitting or lying down). Symptoms may include:
- dizziness or fainting after standing up
- blurred vision after standing
- Hyperprolactinemia (high blood levels of prolactin, a type of hormone). Symptoms may include:
- missed periods
- gynecomastia (increased growth of breast tissue)
- Risk of depression and suicidal thoughts or behaviors.*
- Severe allergic reaction.†
* Xenazine has a
† For details about allergic reaction and Xenazine, see “Allergic reaction” below.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
As with most drugs, some people can have an allergic reaction after taking Xenazine. This side effect wasn’t reported in clinical trials of this drug but can still occur.
Symptoms of a mild allergic reaction can include:
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your tongue, mouth, or throat
- trouble breathing
Call your doctor right away if you have an allergic reaction to Xenazine, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.
The Food and Drug Administration (FDA) approves prescription drugs such as Xenazine to treat certain conditions. Xenazine may also be used off-label for other conditions. Off-label drug use is when an FDA-approved drug is prescribed for a purpose other than what it’s approved for.
Xenazine for uncontrollable movements associated with Huntington’s disease
Xenazine is FDA-approved to treat chorea that’s associated with Huntington’s disease in adults.
Huntington’s disease is a genetic condition that affects the nerves in your brain. The condition is progressive (gets worse over time). While no cure is currently available for the disease, medications are available to manage the symptoms. One such symptom is chorea, which is explained in the section just below.
Uncontrollable movements associated with Huntington’s disease explained
With chorea, you have uncontrollable movements of the legs, arms, and facial muscles. Symptoms may include sudden, random movements or jerking of the limbs or face.
Chorea may be caused by Huntington’s disease (a genetic condition that affects your brain). Note that chorea may be caused by other conditions. However, Xenazine is only approved for chorea related to Huntington’s disease.
Doctors may recommend Xenazine to treat chorea in adults with Huntington’s disease. Chorea itself is not serious or harmful, but the symptoms may be uncomfortable or stressful.
Effectiveness for uncontrollable movements associated with Huntington’s disease
In clinical trials, Xenazine was shown to be effective for treating chorea related to Huntington’s disease. Experts include this drug as a first-line option in
Xenazine and children
Xenazine is not FDA-approved for use in children. Clinical trials of the drug included only adults. It’s not known for sure whether Xenazine is safe or effective for children.
Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Xenazine, talk with your doctor. They can tell you about other medications that may work well for you.
Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use is when a drug that’s approved by the Food and Drug Administration (FDA) is prescribed for a purpose other than what it’s approved for.
Alternatives for uncontrollable movements associated with Huntington’s disease
Examples of other drugs that may be used to manage chorea associated with Huntington’s disease include:
Drinking alcohol while you’re taking Xenazine may increase the risk and severity of drowsiness. This is a common side effect of the drug. Because of this risk, doctors typically recommend not drinking alcohol during treatment with Xenazine.
If you have questions about drinking alcohol during Xenazine treatment, talk with your doctor or pharmacist.
Xenazine can interact with several other medications.
Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe. Drug-condition interactions can also cause certain effects. For information about these interactions, see the “Xenazine precautions” section below.
Before taking Xenazine, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
Xenazine and other medications
Below is a list of medications that can interact with Xenazine. This list does not contain all drugs that may interact with Xenazine.
Certain medications are contraindicated with Xenazine. This means that doctors typically will not prescribe Xenazine with specific drugs due to the risk of serious harm. These drugs include:
- Monoamine oxidase inhibitors (MAOIs). Xenazine should not be taken within 14 days of treatment with an MAOI. Examples of MAOIs include:
- isocarboxazid (Marplan)
- linezolid (Zyvox)
- phenelzine (Nardil)
- selegiline (Emsam, Zelapar)
- tranylcypromine (Parnate)
- Deutetrabenazine (Austedo) or valbenazine (Ingrezza). These drugs are similar to Xenazine and belong to the same class of medications called vesicular monoamine transporter 2 (VMAT2) inhibitors. Only one VMAT2 inhibitor drug should be taken at a time. Combined use increases the risk of the drugs’ side effects.
Certain other medications can interact with Xenazine. This is because certain other drugs can affect how the body metabolizes (breaks down) Xenazine or they can cause some of the same side effects as Xenazine. These interactions could lead to worsened side effects from Xenazine.
Your doctor may adjust your dosage of Xenazine if they prescribe any of the following types of drugs while you’re taking Xenazine. They may also monitor you closely for side effects. These drugs include:
- Strong cytochrome P450 2D6 (CYP2D6) inhibitors (drugs that block a specific enzyme called CYP2D6), such as:
- fluoxetine (Prozac)
- paroxetine (Paxil, Pexeva)
- Drugs that cause sleepiness, such as:
- Drugs that may cause long QT syndrome (a change in the electrical activity of your heart), such as:
- haloperidol (Haldol)
- ziprasidone (Geodon)
- moxifloxacin, an antibiotic
- the heart medications amiodarone (Nexterone, Pacerone) and sotalol (Betapace, Sorine, others)
- Drugs that may cause parkinsonism, neuroleptic malignant syndrome, or akathisia (all of which are possible side effects of Xenazine). Examples include:
- olanzapine (Zyprexa)
- risperidone (Perseris, Risperdal, others)
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Xenazine and herbs and supplements
There aren’t any herbs or supplements that have been specifically reported to interact with Xenazine. However, you should still check with your doctor or pharmacist before using any of these products while taking Xenazine.
Xenazine and foods
There aren’t any foods that have been specifically reported to interact with Xenazine. If you have any questions about eating certain foods with Xenazine, talk with your doctor.
You should take Xenazine according to the instructions your doctor gives you.
Xenazine comes as an oral tablet. You’ll take the drug by mouth, with or without food.
When to take
For the first week of Xenazine treatment, you’ll take the drug once per day in the morning. Then your doctor will likely increase your dosage to one dose taken twice per day (in the morning and in the evening).
It’s possible that your Xenazine dosage may be further increased to three times per day. If so, your doctor or pharmacist can recommend the best dosing schedule for taking Xenazine.
Taking the medication on a regular schedule helps keep a steady level of the drug in your body. This helps Xenazine work effectively.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.
Accessible labels and containers
If your prescription label is hard to read, talk with your doctor or pharmacist. Some pharmacies offer labels that have large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist may be able to direct you to one that does.
If you have trouble opening medication bottles, ask your pharmacist if they can put Xenazine in an easy-open container. They also may be able to recommend tools that can make it simpler to open lids.
Taking Xenazine with food
You may take Xenazine with or without food.
Can Xenazine be crushed, split, or chewed?
The manufacturer of Xenazine hasn’t provided any information on whether the tablets may be crushed or chewed. If you have trouble swallowing Xenazine tablets whole, talk with your doctor for advice.
Regarding splitting the tablets, it depends on the strength of Xenazine you take. The 12.5-milligram (mg) tablet is not meant to be split in half. However, the 25-mg tablets are scored, meaning they have a perforation that allows them to be easily split or cut in half.
Your doctor will tell you how much Xenazine to take and whether your dose requires you to split the tablets.
Xenazine is used to treat chorea related to Huntington’s disease (a genetic condition that affects your brain).
Chorea is the medical term for uncontrollable movements of the legs, arms, and facial muscles. With Huntington’s disease, the involuntary movements are thought to be caused by a buildup of a brain chemical called dopamine.
Xenazine contains the active drug tetrabenazine. It belongs to a class of drugs called selective vesicular monoamine transporter 2 (VMAT2) inhibitors. It works to reduce chorea symptoms by decreasing the amount of dopamine in the brain. This stops dopamine from causing involuntary muscle movements.
How long does it take to work?
Xenazine starts working right away after your first dose. However, it may take several weeks for you and your doctor to find a dosage that works for you.
Talk with your doctor if you have questions about what to expect with Xenazine treatment.
Your doctor will likely recommend that you do not take Xenazine while you’re pregnant. This is because there’s not enough information available to know whether it’s safe to take Xenazine during pregnancy. Xenazine hasn’t been studied in pregnant people.
In animal studies, developmental problems and deaths were observed in fetuses exposed to the drug. However, the results of animal studies don’t always reflect what may happen in humans.
If you’re pregnant or considering becoming pregnant, talk with your doctor about taking Xenazine. They can talk with you about other treatment options.
It’s not known if Xenazine is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re taking Xenazine.
For more information about taking Xenazine during pregnancy, see the “Xenazine and pregnancy” section above.
Your doctor will likely recommend that you do not take Xenazine while you’re breastfeeding.
It’s not known if it’s safe to take Xenazine while breastfeeding. Researchers haven’t studied whether the drug passes into breast milk or what effect it may have on a breastfed child. They also haven’t studied the drug in lactating animals.
If you’re breastfeeding or considering it, talk with your doctor before starting Xenazine. They may recommend other treatment options that may be safer to use during this time.
Here are answers to some frequently asked questions about Xenazine.
Does Xenazine cause long-term side effects?
Xenazine isn’t known to cause long-term side effects. Any side effects that occur during Xenazine treatment should go away after you stop taking the drug or with continued use.
Note that some people experienced slightly worsened symptoms of Huntington’s disease* while taking Xenazine in a 12-week clinical trial. These symptoms were related to mood, cognition, muscle stiffness, and functional ability. Considering this, you and your doctor should periodically discuss whether it’s beneficial for you to continue taking Xenazine.
If you have questions about long-term side effects of Xenazine, talk with your doctor or pharmacist.
* Huntington’s disease is a genetic condition that affects your brain. Xenazine is prescribed to treat uncontrollable movements related to this condition.
Will Xenazine cure my uncontrollable movements associated with Huntington’s disease?
No. Xenazine will not cure chorea or Huntington’s disease. Currently, there is no cure for either condition.
Instead, Xenazine is prescribed to help reduce the symptoms of chorea. If you stop taking Xenazine, your symptoms will likely return or worsen within 12 to 18 hours after your last dose of the drug.
Talk with your doctor if you have questions about what to expect with Xenazine treatment.
Is Xenazine addictive?
No. In clinical trials of the drug, no one showed any signs of becoming dependent on Xenazine. (With drug dependence, you feel like you need a drug to function.)
Also, stopping the drug should not cause withdrawal symptoms. (Withdrawal symptoms are uncomfortable effects that occur when you suddenly stop taking a drug that your body has become dependent on.)
However, you should not stop taking Xenazine unless your doctor tells you to do so. Stopping the drug will make the symptoms of chorea return or worsen. (With chorea, you have uncontrollable movements of the legs, arms, and facial muscles.)
This drug comes with several precautions. These are considered drug-condition interactions.
FDA warning: Risk of depression and suicidal thoughts or behaviors
This drug has a
Taking Xenazine increases the risk of depression and suicidal thoughts or behaviors in people with Huntington’s disease. (Xenazine is used to treat uncontrollable movements associated with this condition.) This risk is increased in people who have a history of depression and in people who’ve had suicidal behaviors in the past. In Xenazine’s clinical trials, depression was commonly reported in people taking the drug, while suicidal thoughts and behaviors were rare.
Huntington’s disease itself is also frequently associated with depression and suicidal tendencies. You and your doctor will decide if the drug’s potential benefits outweigh these risks.
If they prescribe Xenazine, you and your doctor will watch for any changes in your behavior that may be a sign of worsening depression or suicidal thoughts. Your caregivers or household members should also be made aware of these risks so that they can alert your doctor if they notice any behavior changes. The following behavior changes may be a sign of worsening depression or suicidal thoughts:
- having thoughts about hurting yourself
- changes in your sleeping or eating patterns
- feeling sad and hopeless
- loss of interest in doing things you used to enjoy
Because of this risk, doctors typically will not prescribe Xenazine to people who are actively suicidal or people who are not receiving adequate treatment for their depression.
Before taking Xenazine, talk with your doctor about your health history. Xenazine may not be right for you if you have certain medical conditions or other factors affecting your health. These include:
- Liver problems. After taking Xenazine, your liver metabolizes (breaks down) the drug so that your body can eliminate it. If you have any liver problems, such as liver failure, the drug could stay in your system longer than it should. This could increase the risk of side effects from Xenazine. Due to the risk of harm, doctors typically will not prescribe Xenazine to people with liver problems.
- Drug metabolism status. Due to genetic differences, some people metabolize (break down) drugs at a rate that is faster or slower than average. These differences can impact a drug’s effects in your body. Because of this, your doctor may have you get a genetic test before they prescribe a higher dose of Xenazine. This test will check your body’s ability to metabolize Xenazine. The test results will help your doctor determine a dosage range that’s safe for you.
- Certain heart problems. Xenazine may cause changes in your heart’s electrical activity, which can lead to serious heart rhythm problems. People with a history of heart problems, such as arrhythmia or congenital long QT syndrome, may have a higher risk for this side effect. Before starting Xenazine, talk with your doctor about any heart problems you’ve had. They can help determine if the drug is safe for you to take.
- Breast cancer. Xenazine may cause high levels of prolactin (a type of hormone) in your blood. High prolactin levels may increase the growth of certain types of breast cancer. Because of this possibility, your doctor may not recommend Xenazine if you have breast cancer or if you’ve had it in the past.
- Allergic reaction. If you’ve had an allergic reaction to Xenazine or any of its ingredients, your doctor will likely not prescribe Xenazine. Ask your doctor what other medications may be better options for you.
- Pregnancy. It’s not known if Xenazine is safe to take during pregnancy. For more information, see the “Xenazine and pregnancy” section above.
- Breastfeeding. It’s not known if Xenazine is safe to take while breastfeeding. For more information, see the “Xenazine and breastfeeding” section above.
Note: For more information about the potential negative effects of Xenazine, see the “Xenazine side effects” section above.
Using more than the recommended dosage of Xenazine can lead to serious side effects. Do not use more Xenazine than your doctor recommends. (For information on the recommended dosages of Xenazine, see the “Xenazine dosage” section above.)
Symptoms of an overdose can include:
- dystonia (involuntary muscle spasms that cause twisting or repeating movements)
- episode of fixed upward gaze due to muscle spasms around the eyes
- nausea, vomiting, or diarrhea
- low blood pressure
- inflamed skin
What to do in case of overdose
If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.
When you get Xenazine from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee that the medication is effective during this time. The
How long a medication remains good to use can depend on many factors, including how and where you store the medication.
Xenazine tablets should be stored at a room temperature of around 77°F (25°C). The drug may be stored for short periods at temperatures between 59°F to 86°F (15°C to 30°C). Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.
If you no longer need to take Xenazine and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.
This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.