The common use of anticholinergics often leads to exacerbation of choreiform movements of TD.6 In 2017, two vesicular monoamine transporter type 2 (VMAT2) inhibitors were introduced in the US, valbenazine, a valine ester of a highly selective isomeric metabolite of tetrabenazine ([+]-α-dihydrotetrabenazine), and deutetrabenazine, a deuterated form of tetrabenazine.7,8 Both drugs have demonstrated safety and efficacy in double-blind, placebo-controlled clinical trials and are considered first-line therapies for adults with TD.6,9–12. This evidence concerns the gene SLC18A2 and thanatophoric dysplasia.