Editing Huntington's disease (section)

===Medications===
[[File:Tetrabenazine structure.svg|thumb|right|alt=diagram showing 19 carbon, 27 hydrogen, 3 oxygen and 1 nitrogen atom bonded together| Chemical structure of [[tetrabenazine]], an approved compound for the management of [[chorea]] in HD]]
[[Tetrabenazine]] was approved in 2000 for treatment of chorea in Huntington's disease in the EU, and in 2008 in the US.<ref name=autogenerated1>{{cite web |url=https://www.fda.gov/bbs/topics/NEWS/2008/NEW01874.html |title=FDA Approves First Drug for Treatment of Chorea in Huntington's Disease |access-date=10 August 2008 |publisher=U.S. Food and Drug Administration |date=15 August 2008 |url-status=live |archive-url=https://web.archive.org/web/20080821020643/https://www.fda.gov/bbs/topics/NEWS/2008/NEW01874.html |archive-date=21 August 2008}}</ref> Although other drugs had been used "[[off label]]", tetrabenazine was the first approved treatment for Huntington's disease in the U.S. The compound has been known since the 1950s. In 2017, [[deutetrabenazine]], a heavier form of tetrabenazine medication for the treatment of chorea in HD, was approved by the FDA.<ref name="CDE2">{{cite web |author=Center for Drug Evaluation Research |date=17 July 2019 |title=In Pursuit of Tardive Dyskinesia: The Breakthrough Designation and Approval of Valbenazine |url=https://www.fda.gov/drugs/news-events-human-drugs/pursuit-tardive-dyskinesia-breakthrough-designation-and-approval-valbenazine |url-status=live |archive-url=https://web.archive.org/web/20201203175104/https://www.fda.gov/drugs/news-events-human-drugs/pursuit-tardive-dyskinesia-breakthrough-designation-and-approval-valbenazine |archive-date=3 December 2020 |access-date=15 November 2020 |website=FDA |language=en}}</ref> This is marketed as Austedo. [[Valbenazine|Valbenazine (Ingrezza)]] was also approved by the FDA for the treatment of Huntington's disease chorea in 2023.<ref>{{Cite web |title=Ingrezza (valbenazine) FDA Approval History |url=https://www.drugs.com/history/ingrezza.html |access-date=2025-04-25 |website=Drugs.com |language=en}}</ref> [[Tetrabenazine]], [[deutetrabenazine]], and [[valbenazine]] are all [[Vesicular monoamine transporter 2|vesicular monoamine transporter 2 (VMAT2)]] inhibitors, which work by depleting [[dopamine]] in the brain, lessening involuntary movements.<ref>{{Cite journal |last=Tarakad |first=Arjun |last2=Jimenez-Shahed |first2=Joohi |date=December 2018 |title=VMAT2 Inhibitors in Neuropsychiatric Disorders |url=https://pubmed.ncbi.nlm.nih.gov/30306450 |journal=CNS drugs |volume=32 |issue=12 |pages=1131–1144 |doi=10.1007/s40263-018-0580-y |issn=1179-1934 |pmid=30306450}}</ref> These are the only drugs that have been approved specifically for Huntington's disease (namely the chorea associated with it).

Other drugs that help to reduce chorea include [[antipsychotic]]s and [[benzodiazepine]]s.<ref name="genereviews"/> [[Hypokinesia]] and rigidity, especially in juvenile cases, can be treated with [[antiparkinsonian]] drugs, and [[myoclonic]] hyperkinesia can be treated with [[valproic acid]].<ref name="genereviews"/> Tentative evidence has found [[ethyl eicosapentaenoic acid]] to improve motor symptoms at one year.<ref>{{cite journal | vauthors = Morsy S, Khalil SM, Doheim MF, Kamel MG, El-Basiony DS, Ahmed Hassan HI, Eisa AA, Anh Ngoc CT, Dang NP, Hirayama K, Huy NT | title = Efficacy of ethyl-EPA as a treatment for Huntington disease: a systematic review and meta-analysis | journal = Acta Neuropsychiatrica | volume = 31 | issue = 4 | pages = 175–185 | date = August 2019 | pmid = 30890195 | doi = 10.1017/neu.2019.11 | hdl-access = free | hdl = 10069/39427| s2cid = 84183892 }}</ref> [[Amantadine]] has also been used to treat chorea, but there is limited evidence for its safety and efficacy.<ref name="Coppen2">{{cite journal |vauthors=Coppen EM, Roos RA |date=January 2017 |title=Current Pharmacological Approaches to Reduce Chorea in Huntington's Disease |journal=Drugs |volume=77 |issue=1 |pages=29–46 |doi=10.1007/s40265-016-0670-4 |pmc=5216093 |pmid=27988871}}</ref>

Psychiatric symptoms can be treated with medications similar to those used in the general population.<ref name="lancet07" /><ref name="pmid15076012"/> [[Selective serotonin reuptake inhibitor]]s and [[mirtazapine]] have been recommended for depression, while [[atypical antipsychotic]]s are recommended for [[psychosis]] and behavioral problems.<ref name="pmid15076012"/> Specialist neuropsychiatric input is recommended since people may require long-term treatment with multiple medications in combination.<ref name="lancet07" />