Abnormal involuntary movements often improve in response to anti-dopaminergic 
drugs. In contrast to classic neuroleptics that block dopamine receptors, drugs 
that deplete presynaptic dopamine by blocking vesicular monoamine transporter 
type 2 (VMAT2) seem to be safer and have little or no risk of tardive 
dyskinesia. This is one reason why there has been a recent emergence of novel 
VMAT2 inhibitors. Areas covered: Since the approval of tetrabenazine, the 
classic VMAT2 inhibitor, in the treatment of chorea associated with Huntington 
disease (HD), other VMAT2 inhibitors (e.g. deutetrabenazine and valbenazine) 
have been studied in the treatment of HD-related chorea, tardive dyskinesia and 
tics associated with Tourette syndrome. This review, based largely on a detailed 
search of PubMed, will summarize the pharmacology and clinical experience with 
the various VMAT2 inhibitors. Expert commentary: Because of differences in 
pharmacology and pharmacokinetics these new VMAT2 inhibitors promise to be at 
least as effective as tetrabenazine but with a lower risk of adverse effects, 
such as sedation, insomnia, depression, parkinsonism, and akathisia.