CONFERENCE REPORTER
Make sure you are offering your patients with tardive dyskinesia an adequate medication trial, Alejandro Alva, MD, told attendees of the Southern California Psychiatry Conference.1
Between the 2 FDA approved medications for treatment of tardive dyskinesia, efficacy rates are similar; when trying out medications, clinicians can always try one and then switch to the other option if needed.2 Alva noted he personally goes with the option that the patient can access quickly and easily so that they can benefit fastest. In deciding which option is best, monitoring results closely is crucial. He added that it is also important to “push the dose” to what we “consider to be the maximum efficacious dose. A lot of clinicians tend to under-dose, and when they under-dose, we don’t see the benefits” of the medication. If the optimal dose is not reached, then the patient does not show a response to the medication, and the clinician may then decide to discontinue the medication. Because the best dose was not reached for the patient, medications might be discontinued before it can truly be evaluated if the medication had an effect, he said.
Alva’s stance here was to “Push the dose. See what happens.” Pushing the dose can be a useful choice because under-dosing leaves the patient and the clinician unaware if the medication worked. He says specifically that in this specialty setting of psychiatry, prescribers need to be careful with choosing doses that are appropriate and ensure that patients give the medication a trial long enough for it to have an effect. Alva says a period “of 4 weeks at the very least” is needed to determine if a medication is effective for a patient. After this period, then the medication can be reevaluated. If the clinician and patient feel switching to a different prescription would be beneficial, then they may choose to do so. Giving the medication an opportunity to have an effect, and choosing a dose that will make an impact, are important in assisting patients.
Dr Alva is the founder, chief medical officer, and CEO of Pacific Neuropsychiatric Specialists. He has been practicing psychiatry for more than 20 years.
References
1. Alva A, Meyer J, Hanaie J. Improving tardive dyskinesia management: tackling complex care with targeted treatments. Conference Proceedings of the Southern California Psychiatry Conference. July 2025;11-12. Huntington Beach, CA.
2. McEvoy JP. FDA-approved medications to treat tardive dyskinesia. J Clin Psychiatry. 2019;81(1):NU18041BR3C.