Vintelix 5

Indications

Vintelix is prescribed for the management of major depressive disorder (MDD) in adults. Before starting Vintelix, it is crucial to evaluate its benefits and risks and consider other treatment alternatives. For optimal outcomes, use the lowest effective dose for the shortest period that meets the patient’s therapeutic goals.

Pharmacology

Vintelix, containing vortioxetine, is an antidepressant that improves mood by enhancing serotonergic activity in the brain. It works primarily by inhibiting serotonin (5-HT) reuptake and also interacts with serotonin receptors, including antagonizing 5-HT3 and agonizing 5-HT1A receptors.

Dosage & Administration

• Initial Dose: Start with 10 mg once daily, regardless of food intake. The dose may be increased to 20 mg/day based on tolerance. Higher doses have not been studied extensively. For patients who cannot tolerate higher doses, a reduction to 5 mg/day may be considered. For elderly patients (>65 years), begin with 5 mg/day.
• Maintenance: Vintelix can be used for several months or longer for MDD. Patients should be periodically reassessed to determine ongoing efficacy.
• Discontinuation: Abrupt discontinuation may cause temporary adverse effects like headache and muscle tension. To minimize these reactions, reduce the dose to 10 mg/day for a week before stopping completely.
• Switching from/to MAOIs: Allow at least 14 days between stopping an MAOI and starting Vintelix, and at least 21 days before starting an MAOI after stopping Vintelix, to prevent serotonin syndrome.

Note: Use medication only as directed by a healthcare professional.

Interactions

• MAOIs: Risk of serious reactions if MAOIs are used concurrently or recently discontinued.
• Serotonergic Drugs: Combining Vintelix with other serotonergic agents may increase the risk of serotonin syndrome. Monitor for symptoms closely.
• Other CNS Agents: No significant interaction with steady-state Lithium exposure.
• Drug Interactions: Reduce Vintelix dosage by half with strong CYP2D6 inhibitors; consider dose increase with CYP inducers.

Contraindications

Vintelix is contraindicated in patients with known hypersensitivity to vortioxetine or its components and those using Monoamine Oxidase Inhibitors (MAOIs).

Side Effects

Possible side effects include hypersensitivity, clinical worsening, serotonin syndrome, abnormal bleeding, mania/hypomania, angle closure glaucoma, and hyponatremia.

Pregnancy & Lactation

• Pregnancy: Category C. Use only if the benefits outweigh the risks to the fetus. Avoid during the third trimester due to potential effects on fetal cardiovascular development.
• Lactation: Not recommended during breastfeeding due to potential risks to the infant.

Precautions & Warnings

• Clinical Worsening & Suicide Risk: Monitor patients for worsening symptoms or suicidal thoughts, especially during initial treatment or dose changes.
• Serotonin Syndrome: Be vigilant for serotonin syndrome, particularly when Vintelix is used with other serotonergic drugs.
• Abnormal Bleeding: Increased risk of bleeding, particularly with other anticoagulants or NSAIDs.
• Mania/Hypomania: Use cautiously in patients with a history of bipolar disorder.
• Angle Closure Glaucoma: Risk of angle closure in patients with narrow angles.
• Hyponatremia: Risk associated with serotonergic drugs.

Use in Special Populations

• Pediatric: Safety and efficacy in children under 18 have not been established.
• Geriatric: No dose adjustment required for elderly patients.
• Renal Impairment: No adjustment needed.
• Hepatic Impairment: No adjustment for mild or moderate impairment; not recommended for severe hepatic impairment.
• CYP2D6 Poor Metabolizers: May require dosage adjustments due to higher plasma levels.

Overdose Effects

Limited data is available on Vintelix overdose. Medical follow-up in a specialized setting is recommended for management.

Therapeutic Class

Serotonin-norepinephrine reuptake inhibitor (SNRI)

Storage Conditions

Store at 30°C or below in a dry place, away from light. Keep out of reach of children.