Vortioxetine (Trintellix) is an antidepressant with many actions (also termed a multimodal antidepressant). In addition to being a serotonin reuptake inhibitor, Vortioxetine has numerous effects at other receptor sites which work together in complex and poorly understood ways to produce an antidepressant effect.
ROUTE OF ADMINISTRATION: Oral
HALF-LIFE: 66 hours
TIME TO STEADY STATE: 2 weeks
PEAK IN PLASMA: 7-11 hours
PLASMA PROTEIN BOUND: 98%
METABOLISM: Hepatic; Phase I+II; CYP2D6; Inactive metabolites
HEPATIC IMPAIRMENT (HI): No dose adjustment for mild/moderate HI
RENAL IMPAIRMENT (RI): No dose adjustment needed
FOOD or FAST (PO)? Either
~10mg PO daily (18-65 years old)
~5mg PO daily (>65 years old)
TARGET DOSING RANGE: 5-20mg / day
BEST TIME TO DOSE: Morning after a meal or night
HOW TO DOSE:
>>Start 5mg-10mg per day and increase dose by 5mg after two (2) weeks based on response and tolerability.
>>Max dose typically 20mg/day
PREGNANCY: Not enough information.
BREASTFEEDING: Not enough information.
Nausea (Dose dependent; usually first few weeks), vomiting, constipation
- Avoid with MAOIs
- If switching from or to an MAOI, washout is 2 weeks
- Not an inducer/inhibitor of CYP450
- If given with 2D6 Inhibitors (paroxetine, fluoxetine), AUC is doubled
- May reduce effects of triptans used for migraines (via 5HT1D antagonism)
- Major depressive disorder
Mechanism(s) of Action
- SERT Inhibition (serotonin reuptake inhibition)
- 5HT1A Full Agonist
- 5HT1B Partial Agonist
- 5HT1D Antagonist
- 5HT3 Antagonist
- 5HT7 Antagonist
- Some evidence that vortioxetine improves cognitive symptoms of depression
- Minimal to no sexual dysfunction at dosages of 5mg-10mg
- Dosages of 20mg/day showed similar sexual side effects as duloxetine 60mg/day
- Minimal to no withdrawal syndrome (due to long half-life)
- Minimal to no effects on body weight
- No clinically meaningful QTc changes after 14 days of 40mg/day
- Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
- Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
- Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.