What Is Tetrabenazine? Uses, Dosage, and What You Need to Know in 2026

Tetrabenazine is one of the most important medications in the treatment of Huntington's disease — and one of the least talked about outside of the neurology world. Whether you're a newly diagnosed HD patient, a caregiver, or simply researching your options, this guide covers everything you need to know about Tetrabenazine in plain language.

What Is Tetrabenazine?

Tetrabenazine (brand name Xenazine) is a prescription medication in the drug class called VMAT2 inhibitors (vesicular monoamine transporter 2 inhibitors). It was FDA-approved on August 15, 2008 to treat chorea — the involuntary, irregular, dance-like movements — associated with Huntington's disease (HD). This made it the first drug ever approved by the FDA specifically for Huntington's disease in the United States.

Tetrabenazine does not cure Huntington's disease or slow its progression. It provides symptomatic relief by reducing the severity of chorea, which can significantly improve quality of life and reduce the risk of injury from falls.

What Is Tetrabenazine Used For?

FDA-approved indication:

Chorea associated with Huntington's disease — in adults

Off-label uses (not FDA-approved but used by physicians in clinical practice):

Tardive dyskinesia (involuntary movements caused by long-term antipsychotic use)

Hemiballismus (spontaneous flinging limb movements)

Tourette syndrome and other tic disorders

Dyskinetic cerebral palsy (in pediatric patients, retrospective studies show benefit)

Tetrabenazine Dosage Forms and Strengths

Tetrabenazine is available as oral tablets in two strengths:

12.5 mg tablet — white or yellowish-buff, round tablet

25 mg tablet — yellowish-buff scored tablet

How Is Tetrabenazine Dosed?

Tetrabenazine dosing is started low and titrated slowly to minimize side effects. The standard approach:

Week 1: 12.5 mg once daily

Week 2: 12.5 mg twice daily (25 mg/day)

Subsequent weeks: Increase by 12.5 mg/day weekly until chorea is adequately controlled or side effects limit further increases

Maximum dose: 50 mg/day without CYP2D6 testing; up to 100 mg/day after CYP2D6 genotyping confirms extensive metabolizer status

Tetrabenazine can be taken with or without food. It may take 2–3 weeks to notice significant improvement in chorea symptoms after starting.

Is Tetrabenazine a Controlled Substance?

No. Tetrabenazine is not a controlled substance under the DEA Controlled Substances Act. Clinical trials did not show patients developing drug-seeking behaviors, and abuse has not been reported in postmarketing experience. This means prescribing is not subject to DEA scheduling restrictions, and telehealth prescribing is permitted.

How Much Does Tetrabenazine Cost in 2026?

Tetrabenazine has a wide price range depending on how you pay:

List price (no discount): ~$4,000–$4,400 per month for 60 tablets

With GoodRx coupon: As low as $60 per fill for generic tetrabenazine

With insurance: Copay varies; typically Tier 4–5 specialty drug. Medicare Part D patients have an annual out-of-pocket cap of $2,000 starting in 2025.

For more detail on saving money, see our Tetrabenazine savings guide. For side effects, read Tetrabenazine Side Effects: What to Expect.