Alternatives to Ingrezza If You Can't Fill Your Prescription

Ingrezza (valbenazine) is one of the most effective treatments available for tardive dyskinesia (TD) and chorea associated with Huntington's disease. But specialty pharmacy requirements, prior authorization hurdles, and high costs mean some patients can't get it when they need it. If you're in that situation, this guide covers the alternatives your doctor may consider — and what you should know about each.

Important: Always discuss medication changes with your prescribing physician before switching or stopping Ingrezza. Abruptly stopping treatment for TD or HD chorea can worsen symptoms.

Option 1: Austedo or Austedo XR (Deutetrabenazine)

Deutetrabenazine (brand names Austedo and Austedo XR, made by Teva) is the most closely related FDA-approved alternative to Ingrezza. Like Ingrezza, it is a VMAT2 inhibitor — it works by reducing the release of excess dopamine in the brain. It is FDA-approved for both tardive dyskinesia and chorea associated with Huntington's disease.

Dosing: Austedo is taken twice daily with food; Austedo XR once daily.

Key difference from Ingrezza: Must be taken with food, and the twice-daily Austedo formulation may be harder for some patients to stick to.

Boxed warning: Same as Ingrezza — depression and suicidal ideation in HD patients.

Cost: Also a specialty drug; Teva offers copay assistance programs. No generic available.

Insurance note: Some insurance plans require trial of Austedo before approving Ingrezza (step therapy), while others do the reverse. Austedo may be preferred on some formularies.

Option 2: Xenazine (Tetrabenazine)

Tetrabenazine (brand name Xenazine, made by Lundbeck) is an older VMAT2 inhibitor and dopamine D2 antagonist. It is FDA-approved only for chorea associated with Huntington's disease, but has been used off-label for tardive dyskinesia. It was available before Ingrezza and Austedo were approved.

Dosing: Multiple doses per day; complex titration required.

Side effect concern: Higher risk of depression, parkinsonism, and sedation compared to newer VMAT2 inhibitors; less selective mechanism.

Who prescribes it: Mainly movement disorder neurologists; also used in HD specialty centers.

Option 3: Clonazepam (Off-Label for TD)

Clonazepam is a benzodiazepine sometimes used off-label to manage tardive dyskinesia symptoms. The American Academy of Neurology (AAN) acknowledges some evidence supports its short-term use. However, clonazepam is a Schedule IV controlled substance with risk of dependence and withdrawal, and it is generally not a first-line alternative for most patients.

Option 4: Reducing or Switching the Offending Antipsychotic

Since tardive dyskinesia is caused by prolonged antipsychotic use, one strategy — where clinically safe — is to work with your psychiatrist to reduce the dose of, or switch to a different, antipsychotic medication. Some antipsychotics (like clozapine and quetiapine) are believed to have lower TD risk. However, this is a complex decision that must be made carefully to avoid worsening underlying psychiatric conditions.

Comparing Ingrezza vs. Its Main Alternatives

Ingrezza: Once daily, can be taken without food, high VMAT2 selectivity, FDA-approved for TD and HD chorea.

Austedo XR: Once daily, must be taken with food, FDA-approved for TD and HD chorea.

Xenazine: Multiple daily doses, older safety profile, not approved for TD (off-label only).

Still Trying to Fill Ingrezza? Try medfinder

Before switching medications, it's worth exhausting every option to fill Ingrezza. medfinder calls pharmacies on your behalf to find which ones can fill your Ingrezza prescription. You provide your medication, dosage, and zip code — and we do the legwork.

Also read: How to find Ingrezza in stock near you for a full walkthrough.