vilazodone

ROUTE	ONSET	PEAK	DURATION
PO	unknown	4–5 hr	unknown

Contraindicated in:

Concurrent use of MAO inhibitors or MAO-inhibitor-like drugs (linezolid or methylene blue).

Use Cautiously in:

May ↑ risk of suicide attempt/ideation especially during early treatment or dose adjustment; this risk appears to be greater in adolescents or children
;
Bipolar disorder (may ↑ risk of mania/hypomania);
Angle-closure glaucoma;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. May worsen or cause syndrome of inappropriate antidiuretic hormone (SIADH) secretion and/or hyponatremia in older adults. Use with caution in older adults and closely monitor sodium concentrations when starting therapy or ↑ dose.

Adv. Reactions/Side Effects ⬆ ⬇

Endo: SIADH

F and E: hyponatremia

GI: diarrhea, nausea, dry mouth, PANCREATITIS, vomiting

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

Hemat: BLEEDING

Neuro: insomnia, abnormal dreams, dizziness, NEUROLEPTIC MALIGNANT-LIKE SYNDROME, restlessness, SEIZURES, sleep paralysis, SUICIDAL THOUGHTS/BEHAVIORS

Misc: SEROTONIN SYNDROME

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with, or use within 14 days of starting or stopping, MAO inhibitors may ↑ risk of neuroleptic malignant syndrome or serotonin syndrome and should be avoided.
MAO-inhibitor-like drugs, such as linezolid or methylene blue, may ↑ risk of serotonin syndrome; concurrent use contraindicated; do not start therapy in patients receiving linezolid or methylene blue; if linezolid or methylene blue need to be started in a patient receiving vilazodone, immediately discontinue vilazodone and monitor for signs/symptoms of serotonin syndrome for 2 wk or until 24 hr after last dose of linezolid or methylene blue, whichever comes first (may resume vilazodone therapy 24 hr after last dose of linezolid or methylene blue).
Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SNRIs, fentanyl, lithium, buspirone, tramadol, meperidine, methadone, amphetamines, and triptans, may ↑ risk of serotonin syndrome.
↑risk of bleeding with NSAIDs, aspirin, clopidogrel, prasugrel, ticagrelor, dabigatran, apixaban, edoxaban, rivaroxaban, or warfarin.
Strong CYP3A4 inhibitors, including ketoconazole, may ↑ levels and risk of toxicity.
Moderate CYP3A4 inhibitors, including erythromycin, may ↑ levels and risk of toxicity; ↓ dose.
Strong CYP3A4 inducers, including carbamazepine, may ↓ levels and effectiveness.

Drug-Natural Products:

↑risk of serotonin syndrome with St. John’s wort.

Route/Dosage ⬆ ⬇

PO (Adults ): 10 mg once daily for one wk; then 20 mg once daily for one wk; dose may be ↑ to 40 mg once daily (recommended dose = 20–40 mg/day). Concurrent use of strong CYP3A4 inhibitors: Not to exceed 20 mg/day; Concurrent use of strong CYP3A4 inducers (if used for >14 days): May need to ↑ dose up to twofold (daily dose should not exceed 80 mg).

Availability ⬆ ⬇

(Generic available)

Tablets: 10 mg; 20 mg; 40 mg

Assessment ⬆ ⬇

Assess mental status and mood changes. Inform health care provider if patient demonstrates significant ↑ in anxiety, nervousness, or insomnia.
Before starting therapy, screen patient for bipolar disorder (detailed psychiatric history, including family/personal history of suicide, bipolar disorder, or depression). Use cautiously in patients with a positive history.
Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be ↑ in adults ≤24 yr. After starting therapy, young adults should be seen by health care provider at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of health care provider thereafter.
Assess for signs and symptoms of hyponatremia (headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness). May require discontinuation of therapy.
Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).
Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, loss of bladder control). Discontinue vilazodone and notify health care provider immediately if these symptoms occur.
Assess baseline sexual function before starting vilazodone. Assess for changes in sexual function during treatment, including timing of onset.

Lab Test Considerations:

Monitor serum sodium concentrations periodically during therapy. May cause hyponatremia potentially as a result of SIADH.
- May alter anticoagulant effects. Monitor patients receiving warfarin, NSAIDs, or aspirin concurrently.

Implementation ⬆ ⬇

PO: Administer vilazodone with food; administration without food can result in inadequate drug concentrations and may ↓ effectiveness.
- When discontinuing therapy after prolonged treatment (>3 wk),↓ dose gradually. If taking 40 mg once daily, ↓ to 20 mg once daily for 4 days, followed by 10 mg once daily for 3 days. If taking 20 mg once daily, ↓ to 10 mg once daily for 7 days. When discontinuing therapy after brief treatment (2–3 wk), taper over 1–2 wk; <2 wk treatment generally does not need taper. Patients with a history of antidepressant withdrawal symptoms or on a high dose may require a slower taper (>4 wk). If intolerable withdrawal symptoms occur during taper, resume the previously prescribed dose and/or ↓ dose at a more gradual rate. Patients with a history of discontinuation syndrome on long-term treatment (>6 mo) may benefit from tapering over >3 mo.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Instruct patient to take as directed at the same time each day. Take missed doses as soon as possible unless almost time for next dose. Do not double doses or discontinue abruptly. Gradually ↓ dose before discontinuation. Emphasize the importance of follow-up exams to monitor progress, and encourage patient participation in psychotherapy.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of Rx, OTC, and herbal products, especially NSAIDs, aspirin, and warfarin, without consulting health care provider.
Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care provider 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 occur.
Advise patient and caregivers to notify health care provider immediately if symptoms of serotonin syndrome occur.
Caution patient of the risk of serotonin syndrome and neuroleptic malignant syndrome, especially when taking triptans, tramadol, tryptophan supplements, and other serotonergic or antipsychotic agents.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.
Caution patient to avoid taking alcohol or other CNS-depressant drugs, including opioids, during therapy.
Inform patient that symptoms of sexual dysfunction can occur. Advise men that ejaculatory delay or failure, ↓ libido, and erectile dysfunction may occur. Advise women that ↓ libido and delayed or absent orgasm may occur. Advise patient to notify health care provider if symptoms occur.
Rep: Advise women of reproductive potential to notify health care provider immediately if pregnancy is planned or suspected or if breastfeeding. Use during last month of pregnancy ↑ risk of postpartum hemorrhage. If used during pregnancy, should be tapered during 3rd trimester to avoid neonatal serotonin syndrome. Monitor infants exposed to vilazodone for excess sedation, restlessness, agitation, poor feeding, poor weight gain, or respiratory distress; may ↑ risk of persistent pulmonary hypertension of the newborn. Encourage pregnant patients to enroll in pregnancy exposure registry that monitors outcomes of women exposed to antidepressants during pregnancy by contacting National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants/.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇