Vortioxetine
TRINTELLIX
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
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
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$200–$1,200/month
Generic entry2027 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityNausea, sexual effects and serotonin toxicity are the principal concerns.
Mechanism of action: Vortioxetine ballicule
Open Vortioxetine in the interactive console ↗
Memory aids: mascots and interaction avatars
Trent Reznor (Nine Inch Nails)
“serotonergic vortex” of nausea
guitar pick-shaped tablets
“Fight the fog (machine) of depression” → cognitive benefits
