Indications 

Nitoman is a prescription oral medication used to reduce uncontrolled movements in conditions such as Huntington’s disease, tardive dyskinesia, hemiballismus, senile chorea, tic, and Tourette’s syndrome. It may also be used for the treatment of psychoses. 

Nitoman contains tetrabenazine as its active ingredient. It belongs to a group of medications known as monoamine depleting agents. Tetrabenazine mainly works by inhibiting the vesicular monoamine transporter 2 (VMAT2), which reduces the levels of monoamines, including dopamine, in nerve terminals. This reduction in monoamines helps to alleviate these involuntary movements. 

Use and Dosage 

Nitoman is available in the form of tablets and should be taken exactly as prescribed by a doctor. Do not crush or chew Nitoman tablets. The medication should be taken whole and swallowed with water. Crushing or chewing the tablets can affect the way the medication is absorbed by the body and can also affect its effectiveness.  

The recommended starting dose for adults is 12.5 milligrams (mg) once a day in the morning, which can be adjusted by a doctor as needed. However, the maximum daily dose is typically not more than 100 mg. Take the medication at the same time each day and do not crush or chew the tablets. 

Take it exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. 

Side Effects 

Common Side Effects 

• Difficulty sleeping 
• Dizziness 
• Drooling 
• Drowsiness 
• Fatigue 
• Nausea 
• Severe dizziness when standing or sitting from a lying position 
• Stomach pain 
• Vomiting 
• Weakness 

Serious Side Effects  

• Agitation 
• Anxiety 
• Changes in sleep 
• Changes in weight 
• Confusion or disorientation 
• Decrease in facial expressions 
• Decreased interest in activities 
• Difficulty starting movement 
• Difficulty swallowing 
• Dizziness 
• Fainting or seizures 
• High fever 
• Increasing restlessness 
• Irritability 
• Low blood pressure 
• Muscle stiffness 
• Muscle stiffness 
• Poor concentration 
• Profuse sweating 
• Racing or irregular heartbeat 
• Sensation of a pounding or irregular heartbeat  
• Speech problems 
• Thoughts of suicide 
• Tremor 

Cautions 

• Tetrabenazine carries a black-box warning because of an increase in depression and suicidal thoughts/attempts. People with Huntington’s disease are more likely to have these side effects.  
• Nitoman should not be used in patients who are breast-feeding, pregnant, or planning to become pregnant.  
• Nitoman should not be used in patients who have hypersensitivity to tetrabenazine or any of its ingredients.  
• Tetrabenazine can cause drowsiness or dizziness, so patients should not drive or operate heavy machinery until they know how the drug affects them.  
• Patients should not consume alcohol while taking Nitoman as it can increase the risk of drowsiness or dizziness. 
• Nitoman may cause parkinsonian-like symptoms, such as tremors, rigidity, and bradykinesia. These symptoms usually resolve after the drug is discontinued. 
• Nitoman can cause a prolonged QT interval, which can lead to a potentially life-threatening arrhythmia called Torsades de Pointes. Patients with a history of QT prolongation, arrhythmias, or heart failure should use caution when taking Nitoman. 
• Tetrabenazine can cause akathisia, which is an intense feeling of restlessness or agitation that can be very uncomfortable. This side effect can be managed by reducing the dose or by using a different medication. 
• Nitoman can cause hypotension, which is a drop in blood pressure that can cause dizziness or fainting. Patients should stand up slowly from a sitting or lying position to avoid this side effect. 
• Tetrabenazine can interact with other medications, such as antipsychotics and antidepressants, which can increase the risk of serotonin syndrome. Patients should inform their doctor of all medications they are taking before starting Nitoman.