Vortioxetine or Trintellix® is an antidepressant that was approved by the FDA in September 2013 for the treatment of major depressive disorder and became available in the United States in early 2014. Here is key information about this medication.
Treatment of major depressive disorder (MDD)
Potential side effects
Please see THIS PAGE for a handout listing both the common and less common side effects of this medication along with the percentages of patients who report them.
Important! Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Initial: 10 mg once daily
Maximum: 20 mg once daily
Important points to consider
1. Vortioxetine can be given with or without food.
2. Dosage can be reduced to 5 mg/day for those who cannot tolerate higher doses.
3. It is recommended that doses of 20 mg/day and 15 mg/day be reduced to 10 mg/day for one week prior to discontinuing treatment, if possible.
4. Do not use MAOIs with or within 21 days of stopping treatment with Trintellix. Do not use Trintellix within 14 days of stopping MAOI.
5. With strong inhibitors of CYP2D6, consider dosage reduction of Trintellix by half. 6. If strong CYP inducers are coadministered for 14 days, consider increasing the dose of Trintellix (up to 3 times maximum).
Dosage forms and strengths
Tablets: 5 mg, 10 mg, 15 mg, and 20 mg
What is the half-life of vortioxetine?
The mean half-life of vortioxetine is 66 hours.
What is the dose of vortioxetine?
Vortioxetine is available as immediate release tablets of 5 mg, 10 mg, and 20 mg. The dose range is 5 to 20 mg/day. The usual starting dose is 10 mg/day. The dose should be increased to 20 mg/day if needed and tolerated.
For patients who are known to be cytochrome P450 2D6 poor metabolizers, the maximum dose should be 10 mg/day.
The Prescribing Information says that vortioxetine can be given without regard to meals, the significance of that is to know that its absorption is not affected by food. But in my opinion, as with other antidepressants, it is best to advise the patient to take vortioxetine after food because its most common adverse effect is nausea.
How much does vortioxetine cost?
In April 2020, the cost of 30 pills of vortioxetine 10 mg or 20 mg was $375 (source: goodrx.com). So the 10 mg and 20 mg pills cost the same.[Optional to read: In May 2015, in the US, a one-month supply of either 10 mg or 20 mg vortioxetine was about $284. For comparison, a one-month supply of Fetzima 40 mg or 80 mg was similar – about $255.]
What is the bottom line regarding vortioxetine?
At this time, the real clinical significance of its multiple receptor effects is not known. Vortioxetine is one more addition to our armamentarium and one more option for the treatment of major depressive disorder. But, in my opinion, it has not been convincingly shown that it has any significant advantage over cheap, generic antidepressants.
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