vortioxetine TRINTELLIX

Class: Multimodal Antidepressant
FDA Indications: MDD
Off-Label Use: GAD, Cognitive Symptoms Associated With Depression, Geriatric Depression
Prescribing
Forms: 5, 10, 20mg tablet
Dose Range: 10-20 mg/day
Starting: Start 10 mg qd; can ↓ to 5 mg once daily or ↑ to 20 mg qd depending on patient response; maximum recommended dose generally 20 mg qd
Stopping: Because of long t½, taper is not necessary

NAMI drug fact sheet

Precautions
Contraindications: Concomitant use of MAOIs
Serious Side Effects: Serotonin syndrome; ↑ risk of SI in children and young adults; may impair platelet aggregation; SIADH
Side Effects: constipation, nausea (26% @ 10mg, versus 9% placebo)
Pharmacodynamics
1° MOA: Selective Serotonin Reuptake Inhibitor
2° MOA:
Target: SERT, 5HT1A, 5HT1B, 5HT1D, 5HT3, 5HT7,
Pharmacokinetics
t½: 66° TMAX:
Substrate of: 2D6; 2B6, 2C9, 2C19, 3A4
Inhibits: ∅ ; Induces:
Active Metabolites:
DDIs
  • - DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-21 day washout period)
  • - 2D6 inhibitors can ↑ serum levels; 2D6 inducers can ↓ serum levels
Misc
  • - unique multimodal mechanism of action
  • - most studies suggest clinically meaningful advantage in terms of tolerability over other serotonergic agents
  • - incidence of sexual side-effects appears particularly low
  • - well tolerated in the elderly
  • - no weight gain
  • - growing evidence of possible cognitive benefits; appears to ↑ frontal cortical activity in a pattern that differs from SSRIs/SNRIs
Special Populations

Category C—No controlled studies in humans.

There are no clinical data regarding the effect on lactation and nursing

No dose adjustment necessary


Renal impairment does not affect clearance.


Hepatic impairment does not affect clearance.

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Last updated June 10 2018 15:40:14. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.