vortioxetine

Endo: SIADH

F and E: hyponatremia

GI: constipation, nausea

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

Hemat: bleeding

Neuro: SUICIDAL THOUGHTS/BEHAVIORS

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

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of MAO inhibitors for psychiatric conditions or within 21 days of discontinuing vortioxetine is contraindicated; do not use vorioxetine within 14 days of discontinuing MAOIs used for psychiatric conditions, nor should vorioxetine be started in patients receiving linezolid or intravenous methylene blue due to risk of serious adverse reactions, including serotonin syndrome.
Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SNRIs, fentanyl, lithium, buspirone, tramadol, meperidine, methadone, amphetamines, and triptans, ↑ risk of serotonin syndrome.
Strong CYP2D6 inhibitors, including bupropion, fluoxetine, paroxetine, or quinidine, may ↑ levels and risk of toxicity.
Strong CYP2D6 inducers, including carbamazepine, phenytoin, or rifampin, may ↓ levels and effectiveness.
↑risk of bleeding with aspirin, NSAIDs, anticoagulants, thrombolytics, antiplatelet agents, and other drugs affecting coagulation.

Drug-Natural Products:

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

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg

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.

US Brand Names ⬆ ⬇

Trintellix

Action ⬆ ⬇

Selectively inhibits the reuptake of serotonin in the CNS. May also act as a 5-HT_1Aagonist and as a 5-HT₃ antagonist.

Therapeutic effects:

Antidepressant action.

Classifications ⬆ ⬇

Therapeutic Classification: antidepressants

Pharmacologic Classification: selective serotonin reuptake inhibitors ssris

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)

ROUTE	ONSET	PEAK	DURATION
PO	1–2 wk	4–8 wk	unknown

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 1st wk of therapy and is dose related. Usually ↓ in frequency after 1st wk, but may persist.
Caution patient to report signs and symptoms of hyponatremia (headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness; these may worsen to hallucinations, syncope, seizures, coma, respiratory arrest, death) to health care provider promptly.
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
.
Caution patient and caregiver to look for signs of activation of mania/hypomania (greatly ↑ 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 provider of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care provider 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 ↓ libido.
Advise patient to notify health care provider if symptoms of hypersensitivity reaction or serotonin syndrome occur or if nausea persists.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Use during last month of pregnancy ↑ 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 ↑ 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.

Pronunciation ⬆

vor-tye-OX-e-teen

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇