Consider a 'medical food' for tardive dyskinesia

In the interesting March 2014 Savvy Psychopharmacology article (Strategies for managing drug-induced tar­dive dyskinesia, Current Psychiatry, March 2014, p. 44-46; [http://bit. ly/1gNALYi]), the authors did not mention a medical food made from the branched-chain amino acids L-Leucine, L-Valine, and L-Isoleucine, which was reviewed by the FDA for the dietary management of tardive dyskinesia (TD) in males.^1,2 Although this product, “Tarvil,” is no longer being manufactured, compounding pharmacies can make it using the same ratio of ingredients that was tested in the clinical trial.¹ It may be worth con­sidering before using tetrabenazine, a medication approved in the United States under the Orphan Drug Act, and launched at $34.25 for a 12.5 mg tablet and $68.50 for a 25 mg tablet.³

Leslie Citrome, MD, MPH
Clinical Professor of Psychiatry & Behavioral Sciences
New York Medical College
Valhalla, NY

 
Dr. Ellingrod responds
On behalf of Dr. Kaspar and myself, we thank Dr. Citrome for his interest and clarification. Because of the brevity of Savvy Psychopharmacology in the pages of Current Psychiatry, we decided to include only information on therapies that are readily available for TD.  We also agree with Dr. Citrome that other treat­ment modalities, which often cost less, should be tried before tetrabenazine is utilized. Most important, judicious use of antipsychotics should be considered before any additional medications are added to the patient’s regimen. 

Vicki L. Ellingrod, PharmD, FCCP
John Gideon Searle Professor of Clinical and Translational Pharmacy
University of Michigan College of Pharmacy and School of Medicine
Ann Arbor, Michigan

In the interesting March 2014 Savvy Psychopharmacology article (Strategies for managing drug-induced tar­dive dyskinesia, Current Psychiatry, March 2014, p. 44-46; [http://bit. ly/1gNALYi]), the authors did not mention a medical food made from the branched-chain amino acids L-Leucine, L-Valine, and L-Isoleucine, which was reviewed by the FDA for the dietary management of tardive dyskinesia (TD) in males.^1,2 Although this product, “Tarvil,” is no longer being manufactured, compounding pharmacies can make it using the same ratio of ingredients that was tested in the clinical trial.¹ It may be worth con­sidering before using tetrabenazine, a medication approved in the United States under the Orphan Drug Act, and launched at $34.25 for a 12.5 mg tablet and $68.50 for a 25 mg tablet.³

Leslie Citrome, MD, MPH
Clinical Professor of Psychiatry & Behavioral Sciences
New York Medical College
Valhalla, NY

 
Dr. Ellingrod responds
On behalf of Dr. Kaspar and myself, we thank Dr. Citrome for his interest and clarification. Because of the brevity of Savvy Psychopharmacology in the pages of Current Psychiatry, we decided to include only information on therapies that are readily available for TD.  We also agree with Dr. Citrome that other treat­ment modalities, which often cost less, should be tried before tetrabenazine is utilized. Most important, judicious use of antipsychotics should be considered before any additional medications are added to the patient’s regimen. 

Vicki L. Ellingrod, PharmD, FCCP
John Gideon Searle Professor of Clinical and Translational Pharmacy
University of Michigan College of Pharmacy and School of Medicine
Ann Arbor, Michigan

In the interesting March 2014 Savvy Psychopharmacology article (Strategies for managing drug-induced tar­dive dyskinesia, Current Psychiatry, March 2014, p. 44-46; [http://bit. ly/1gNALYi]), the authors did not mention a medical food made from the branched-chain amino acids L-Leucine, L-Valine, and L-Isoleucine, which was reviewed by the FDA for the dietary management of tardive dyskinesia (TD) in males.^1,2 Although this product, “Tarvil,” is no longer being manufactured, compounding pharmacies can make it using the same ratio of ingredients that was tested in the clinical trial.¹ It may be worth con­sidering before using tetrabenazine, a medication approved in the United States under the Orphan Drug Act, and launched at $34.25 for a 12.5 mg tablet and $68.50 for a 25 mg tablet.³

Leslie Citrome, MD, MPH
Clinical Professor of Psychiatry & Behavioral Sciences
New York Medical College
Valhalla, NY

 
Dr. Ellingrod responds
On behalf of Dr. Kaspar and myself, we thank Dr. Citrome for his interest and clarification. Because of the brevity of Savvy Psychopharmacology in the pages of Current Psychiatry, we decided to include only information on therapies that are readily available for TD.  We also agree with Dr. Citrome that other treat­ment modalities, which often cost less, should be tried before tetrabenazine is utilized. Most important, judicious use of antipsychotics should be considered before any additional medications are added to the patient’s regimen. 

Vicki L. Ellingrod, PharmD, FCCP
John Gideon Searle Professor of Clinical and Translational Pharmacy
University of Michigan College of Pharmacy and School of Medicine
Ann Arbor, Michigan