Ingrezza Side Effects: What to Expect and When to Call Your Doctor

Like all medications, Ingrezza (valbenazine) can cause side effects. Most are mild and manageable, but some require prompt medical attention. This guide covers what to expect when starting Ingrezza, which side effects are common, which are serious, and how to know when to call your doctor.

Boxed Warning: Depression and Suicidality in Huntington's Disease Patients

Ingrezza carries a boxed warning (the FDA's most serious warning) specifically for patients with Huntington's disease: VMAT2 inhibitors including Ingrezza can increase the risk of depression and suicidal thoughts or behavior in patients with HD. If you are taking Ingrezza for HD chorea, watch carefully for any changes in mood, new or worsening depression, or thoughts of self-harm — and report these immediately to your doctor or call 988 (Suicide & Crisis Lifeline).

This boxed warning does NOT apply to patients taking Ingrezza for tardive dyskinesia only.

Common Side Effects of Ingrezza

The most common side effect in patients taking Ingrezza for tardive dyskinesia is somnolence (sleepiness/sedation), which was reported in ≥5% of patients at twice the rate of placebo. For patients taking Ingrezza for HD chorea, the most common side effects were somnolence/lethargy/sedation, urticaria (hives), rash, and insomnia.

Full list of common side effects:

Somnolence (drowsiness/sedation): The most common side effect. May affect your ability to drive or operate machinery. Avoid driving until you know how Ingrezza affects you.

Fatigue: General tiredness or low energy, especially when first starting therapy.

Balance and gait changes: Some patients report unsteadiness or changes in how they walk.

Nausea: Generally mild and may improve after the first few weeks of treatment.

Urticaria or rash: More commonly reported in HD patients. Monitor for spread or worsening.

Insomnia: Reported primarily in HD patients.

Weight gain: Reported in approximately 2% of TD patients in clinical trials — not a common side effect.

Serious Side Effects: Call Your Doctor Right Away

The following side effects are less common but require immediate medical attention:

Angioedema (allergic swelling): Swelling of the face, lips, tongue, throat, or eyelids. This can be life-threatening if it involves the airway. Stop Ingrezza and go to the nearest emergency room immediately.

Parkinson-like symptoms: Shakiness (tremor), muscle stiffness, drooling, difficulty walking, or balance problems. Reported in about 3–5% of patients. Your doctor may need to reduce the dose.

QT prolongation: A change in heart rhythm. More significant when combined with other QT-prolonging drugs. Avoid Ingrezza if you have congenital long QT syndrome.

Neuroleptic Malignant Syndrome (NMS): A rare but dangerous reaction: high fever, muscle rigidity, confusion, and unstable blood pressure. Stop Ingrezza and seek emergency care immediately.

Depression and suicidal thoughts (HD patients): Boxed warning. Report any mood changes to your doctor immediately.

Tips for Managing Common Side Effects

Drowsiness: Take Ingrezza at the same time each day. If drowsiness is problematic, ask your doctor if taking it at night is appropriate for you.

Driving: Do not drive or operate heavy machinery until you know how Ingrezza affects you — especially in the first few weeks.

Alcohol: Avoid alcohol and other sedating substances while taking Ingrezza — they add to the sedation effect.

For information on drug interactions that can increase side effect risk, see: Ingrezza drug interactions: What to avoid.

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