Health care

Harvard Health Ad Watch: Are you having side effects? There is medicine for that – Harvard Health

A shaking hand holding a glass and a second hand holding a hand for support; two glass figures against a peach background.

It’s an unfortunate truth: all medications can cause side effects. While there are several tried and true ways to deal with drug side effects, here’s an unusual option to consider: adding a second medication.

That’s the approach taken with valbenazine (Ingrezza), a drug approved for a condition called tardive dyskinesia caused by certain medications, many of which are mental health. Let’s take a look at what TD is, how this drug is marketed, and what else to consider if the drug you’re taking is causing TD.

What is tardive dyskinesia?

Tardive dyskinesia (TD) is a condition characterized by involuntary movements of the face or hands, such as rapid eye blinking, twitching or tongue thrusting. TD is caused by long-term use of certain drugs, many of which treat psychosis.

TD may not be refunded. Early detection is key to recovery and preventing symptoms from worsening. If you are taking antipsychotics or other drugs that can cause TD, tell your health care provider right away about any troubling symptoms.

Sidewalk sales, park cookout, and yard

Another ad for Ingrezza begins with a young man working with customers at a roadside stand. Although her mental health is better, she says, she now suffers from TD, a condition that “can be caused by some mental health medications.” The light shines on his hands as he fumbles and drops the instant camera he is selling. He seems shy and his customers look confused.

Next we see a young woman in a park cooking area. A strange expression forms on his face as he blinks and cries involuntarily. His voiceover explains that he feels like his involuntary movements are “always in the open.”

Later the two children interacted happily with each other, their movement problems improved significantly. Word tells us that Ingrezza is the #1 treatment for adults with TD. The dosage — “one pill regularly, once a day” — can improve unwanted movements in seven out of 10 people. And people taking Ingrezza can stay on many mental health medications.

That’s the point. Side effects will follow.

What are the side effects of this drug to manage side effects?

As required by the FDA, the advertisement lists the common and serious side effects of Ingrezza, including

  • drowsiness (the most common side effect)
  • depression, suicidal thoughts, or actions
  • heart rhythm problems
  • allergic, which can be life-threatening
  • fever, muscle stiffness, or thinking problems, which can be life-threatening
  • unusual movements.

Of course, one possible side effect is abnormal movement – which is the symptom this drug is supposed to treat!

What advertising does

Advertising

  • rightly highlights TD as a distressing but treatable condition that can cause depression and shame and affect a person’s ability to work.
  • emphasizes once-daily dosing, probably because the recommended dose of the competing drug for TD is twice-daily.
  • shares medical studies that support claims of success
  • covers many widespread and serious consequences.

What else should you know?

Unfortunately, the ad glosses over – or completely skips over – some important details. Below are a few examples.

What medications cause TD?

We never learn which medications can cause TD (especially when used long term), which seems important to know. Many, but not all, are used to help treat certain mental illnesses, such as schizophrenia or bipolar disorder. Here are some of the most common.

Mental health medications:

  • Haloperidol (haloperidol)
  • Fluphenazine (Prolixin)
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa).

Other types of medications:

  • metoclopramide (Reglan), which may be prescribed for nausea, heartburn, and a stomach problem called gastroparesis
  • prochlorperazine (Compazine, Compro), is often prescribed for severe nausea, migraine headaches, or vertigo.

Also, the advertisement does not explain that TD may not be refundable regardless of treatment. Because improvement can occur if caught early, it’s important that people taking these medications talk to their healthcare provider if they notice the TD symptoms described above — especially if the symptoms are getting worse.

What about efficiency and cost?

Seven out of 10 people report that their symptoms have improved, according to the ad. How much improvement? That is not shared. But here’s what I learned from the important lesson:

  • Of the 202 participants with TD, only 24% reported having little or no symptoms of TD after six weeks of treatment with Ingrezza.
  • Up to 67% of study subjects reported minor improvements in symptoms.

What happens after six weeks? The following few small studies suggest that some people who continue to take Ingrezza may improve over time.

And the cost? That is also never mentioned in the ad. That’s $8,700 a month. No information about the financial assistance program, or who qualifies for free treatment, was provided.

Are there other ways to manage TD?

Yes, yes. But the ad doesn’t talk about them either. The three ways to communicate with a health care provider are:

  • Avoid drugs known to cause TD when other options are available.
  • If you need to take these medications, it is safe to use the lowest effective dose for the shortest possible time. For example, limiting metoclopramide for less than three months lowers the risk of TD.
  • If you notice symptoms of TD, ask about lowering the dose or stopping the offending drug immediately. This may be effective in changing, or reducing symptoms.

If you have TD, you and your healthcare provider may consider several options:

  • whether other non-labeled drug treatments for TD, such as deutetrabenazine (Austedo) or tetrabenazine (Xenazine), may cost less or reduce bothersome side effects.
  • botulinum toxin (Botox) injections, which can relax muscle contractions that cause unsteady movements
  • deep brain stimulation, which involves electrical stimulation of certain parts of the brain to disrupt the signals of the nerves to contract abnormally.

Important point

The idea of ​​treating the side effects of a drug with another drug may not appeal. Of course, it makes sense to try other options first.

But sometimes there are no good manners. It is always important to ask if the treatment is worse than the disease. But TD is a condition where all options – including drug therapy for side effects of other drugs – should be considered.

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