section name header

Pronunciation ⬇

vor-tye-OX-e-teen

Classifications ⬆ ⬇

Therapeutic Classification: antidepressants

Pharmacologic Classification: selective serotonin reuptake inhibitors ssris

Indications ⬆ ⬇

BEERS REMS

Action ⬆ ⬇

  • Selectively inhibits the reuptake of serotonin in the CNS. May also act as a 5-HT1Aagonist and as a 5-HT3 antagonist.
Therapeutic effects:
  • Antidepressant action.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed (75%) following oral administration.

Distribution: Extensive extravascular distribution.

Protein Binding: 98%.

Metabolism/Excretion: Primarily metabolized by the liver via the CYP2D6 isoenzyme; the CYP2D6 enzyme system exhibits genetic polymorphism (∼7% of population may be poor metabolizers and may have significantly ↑ vortioxetine concentrations and an ↑ risk of adverse effects). 59% excreted in urine as metabolites, 26% in feces as metabolites, minimal renal excretion of unchanged drug.

Half-Life: 66 hr.

Time/Action Profile ⬆ ⬇

(antidepressant effect)

ROUTEONSETPEAKDURATION
PO1–2 wk4–8 wkunknown





Contraind./Precautions ⬆ ⬇

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects ⬆ ⬇

Endo: SIADH

F and E: hyponatremia

GI: constipation, nausea

GU: ↓libido, delayed/absent orgasm, ejaculatory delay/failure, erectile dysfunction

Hemat: bleeding

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), SEROTONIN SYNDROME

Interactions ⬆ ⬇

Drug-drug:

Drug-Natural Products:

Route/Dosage ⬆ ⬇

  • PO (Adults ): 10 mg once daily initially; may ↑ to 20 mg once daily; some patients may only tolerate daily doses of 5 mg; CYP2D6 poor metabolizers: daily dose should not exceed 10 mg; Concurrent use of CYP2D6 inhibitors: ↓dose by 50%; Concurrent use of strong CYP2D6 inducers for >14 days: consider ↑ dose (not to exceed three times the original dose). If daily dose 15–20 mg/day, do not discontinue abruptly; taper to 10 mg/day for 1 wk before discontinuing.

Availability ⬆ ⬇

(Generic available)
  • Tablets: 5 mg; 10 mg; 20 mg

Assessment ⬆ ⬇

  • Monitor mood changes. Inform health care professional if patient demonstrates significant increase in anxiety, nervousness, or insomnia.
  • Screen patients for personal or family history of bipolar disorder, mania, or hypomania prior to starting therapy.
  • Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. After starting therapy, young adults should be seen by health care professional at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of health care professional thereafter.
  • Monitor for signs and symptoms of hypersensitivity reactions (rash, hives, swelling, difficulty breathing). Stop vortioxetine and treat symptomatically.
  • Assess for sexual side effects (erectile dysfunction; decreased libido).
  • Monitor for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).

Lab Test Considerations:

  • May cause hyponatremia.

Implementation ⬆ ⬇

  • To avoid serotonin syndrome, allow at least 14 days between discontinuation of an MAO inhibitor and starting vortioxetine. Allow at least 21 days after stopping vortioxetine before starting an MAO inhibitor.
  • PO: Administer once daily at the same time each day without regard to meals.

Patient/Family Teaching ⬆ ⬇

  • Instruct patient to take vortioxetine at the same time each day as directed. Advise patient taking 15 mg/day or 20 mg/day of vortioxetine not to stop abruptly; may cause headache, muscle tension, mood swings, sudden outbursts of anger, dizziness, and runny nose. Instruct patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
  • Inform patient that nausea is common in first wk of therapy and is dose related. Usually decreases in frequency after first wk, but may persist.
  • Caution patient to report signs and symptoms of hyponatremia (headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness, and may worsen to hallucinations, syncope, seizures, coma, respiratory arrest, death) to health care professional promptly.
  • Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur.
  • Caution patient and caregiver to look for signs of activation of mania/hypomania (greatly increased energy, severe sleeping problems, racing thoughts, reckless behavior, unusually grand ideas, excessive happiness or irritability, talking more or faster than usual), especially in patients with a history or family history of bipolar disorder, mania, or hypomania.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially St. John's wort. Advise patient to avoid taking other CNS depressants or alcohol. Also taking aspirin, NSAIDs, warfarin, or other anticoagulants may increase risk of bleeding.
  • Inform patient that medication may cause decreased libido.
  • Advise patient to notify health care professional if symptoms of hypersensitivity reaction or serotonin syndrome occur or if nausea persists.
  • Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Use during last mo of pregnancy increases risk of postpartum hemorrhage. If taken during the 3rd trimester, may risk of neonatal complications requiring prolonged hospitalization. Newborn may have toxicity or withdrawal symptoms resulting in breathing difficulty (respiratory distress, cyanosis, apnea, seizures, temperature instability feeding difficulties, behavioral issues) and may increase risk of persistent pulmonary hypertension of the newborn. Consider benefits of breastfeeding, mother's need for vortioxetine, and potential adverse effects on child before breastfeeding.
  • Emphasize the importance of follow-up exams to monitor progress.

Evaluation/Desired Outcomes ⬆ ⬇

  • Increased sense of well-being.
    • Renewed interest in surroundings. May require 1–4 wk of therapy to obtain antidepressant effects.

US Brand Names ⬆

Trintellix