Vortioxetine
TRINTELLIX
Pronunciation: vor-tye-OX-e-teen
“Trent’s Vortex”
Trent Reznor (Nine Inch Nails)
“serotonergic vortex” of nausea
guitar pick-shaped tablets
“Fight the fog (machine) of depression” → cognitive benefits
What it isSerotonin reuptake inhibitor with additional receptor modulation; depression.
Why this oneEvidence for improving cognitive symptoms of depression, and less sexual dysfunction than an SSRI.
What limits itNausea is dose-related and the commonest reason for stopping. CYP2D6-dependent, and cost is a barrier.
FDA-approved for
- depression (2013)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder (MDD) | adult | 10 mg QD | 20 mg QD | 20 mg QD |
| MDD | CYP2D6 poor metabolizers | 10 mg QD | 10 mg QD | 10 mg QD |
Renal Undefined
Hepatic Undefined
5 mg/day may be considered for patients who do not tolerate higher doses
Instructions
- Take without regard to meals
- Taper: reduce 15 or 20 mg/day to 10 mg/day for 1 week before full discontinuation
- Allow 14 days after stopping an MAOI before starting; allow 21 days after stopping before starting an MAOI
Available strengths
- tab 5, 10, 20 mg
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
Cautions
- Serotonin syndrome
- Increased risk of bleeding (with NSAIDs, aspirin, warfarin, anticoagulants)
- Activation of mania/hypomania — screen for bipolar disorder
- Angle closure glaucoma
- Hyponatremia/SIADH
- Sexual dysfunction
- Discontinuation syndrome
Adverse reactions
- Nausea
- Constipation
- Vomiting
Pregnancy Limited data; third-trimester use may increase risk of PPHN and neonatal complications
Lactation No human milk data; weigh benefits against clinical need
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 5 mg | tab | 30 qd | — | $515.90 | not offered |
| 10 mg | tab | 30 qd | — | $515.92 | not offered |
| 20 mg | tab | 30 qd | — | $515.99 | not offered |
Generic entry2027 est.
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityNausea, sexual effects and serotonin toxicity are the principal concerns.
Serotonin and MAOI
Provisional washout figures
Elevating mechanismSRI
Non-elevating action5-HT1A agonist; 5-HT1B partial agonist; 5-HT3/5-HT7 antagonist
Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition
Washout BEFORE an MAOI21 days
Evidence confidenceHigh
InterpretationClinically significant SRI despite multimodal receptor marketing. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.
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