Table 1.
List of compounds used to treat hyperkinesia in Huntington’s disease
| Drug | Dosing | Important potential side effects |
|---|---|---|
| Tetrabenazine |
Starting dose: 2 × 12,5 mg Target dose: up to 3 × 75 mg per day max. daily dose ~ 200 mg If sedative side effects occur, consider dividing the medication into four separate doses, with the primary dosage administered as the nighttime medication |
Depression/suicidality, sedation, sleep disorders, and extrapyramidal side effects, Parkinsonism, akathisia Rare cases of a neuroleptic malignant syndrome Do not combine with MAO inhibitors! |
| Tiaprid |
Starting dose: 2 × 50 mg Target dose: up to 4 × 300 mg pro Tag Max. Daily dose ~ 300 to 1000 mg. One study used up to 3000 mg daily If sedative side effects occur, consider dividing the medication into four separate doses, with the primary dosage administered at nighttime |
Side effects similar to another classic dopamine D2 receptor antagonists, in particular sedation and Parkinsonism |
| Atypical neuroleptics, e.g. risperidone, olanzapine and aripiprazole | Similar to psychiatric indications |
Only smaller studies and case reports Occasionally Parkinsonism monitoring for impulsivity and impulse control disorders for aripiprazole (Risperidone may also be helpful for the treatment of irritability; Olanzapine may also be beneficial for the treatment of weight loss) |
| Haloperidol | Similar to psychiatric indications 5 to 10 mg/day (as evening dose) sufficient in most cases |
Side effects of a classic Dopamine receptor antagonists, esp. Parkinsonism not drug of the first choice possibly useful in cases with psychosis or aggressive behavior |
| Amantadine | 100 to 400 mg daily dose (divided into 2 to 4 single doses) | Data partially contradictory Caution: Psychosis! (consensus strength 80%) |
| Valproate | effect dose-dependent | Rarely indicated in myoclonic Hyperkinesia (action myoclonus; [6, 10, 53]) |
| Levetiracetam | Up to 2 × 1500 mg per day | Only small studies and case reports Parkinsonism, sedation, cognitive disorders, increased irritability! |