What is your approach to Tardive Dyskinesia when VMAT2 inhibitors are ineffective or unaffordable?

In established cases of tardive dyskinesia, in which withdrawal-emergent dyskinesia has been ruled out, and dyskinesia has persisted despite a sufficient washout interval after removal of the offending agent, VAM2 inhibitors such as valbenazine and deutetrabenazine are used for pharmacotherapy. If t...

I have found amantadine very helpful both as an adjunctive agent with a VMAT2 and also as monotherapy.

I’m wondering if TD is remedied with amantadine, will the TD re-emerge as amantadine does have dopamine agonism?

I have also had success using over-the-counter Ginkgo biloba 120 mg twice a day (best with some food). Make sure the patient does not have any bleeding or bruising, and is not on other anticoagulants. One of the neurologists at UPenn told me about this as an alternative treatment. I’ve used this in ...