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Side Effects: Sedation Parkinsonism symptoms QT prolongation (may be significant if taking with drugs inhibiting CYP3A4/5 or 2D6) Pharmacokinetics: undergoes rapid hepatic metabolism involving carbonyl reductase and CYP2D6 to 2 deuterated active metabolites -dihydrotetrabenazine (-HTBZ) and -dihydrotetrabenazine (-HTBZ), with eventual renal elimination of metabolites the -HTBZ and -HTBZ metabolites are primarily responsible for the pharmacological & therapeutic effects produced by the parent prodrug twice a day dosing effect half life 9.4 hours (Schneider et al, 2021) HT: Resistant Hypertension

In various in-vivo and in-vitro studies, exogenous administration of IGF-1 mediated has been shown to increase glucose utilization, release acetylcholine from neurons, activate N-methyl-D-aspartate receptor (NMDA), protect the cerebromicrovascular environment, and maintenance of synaptic structure and function [36, 41,42,43,44,45]

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