What are alternative treatments to Viibryd (vilazodone) if it becomes inaccessible due to cost?

From the Guidelines

If you're unable to get Viibryd (vilazodone) due to cost, the best alternative is likely sertraline (Zoloft), which is a preferred agent with a favorable adverse effect profile and a cost of around $7-10 per month as a generic 1. When considering alternatives to Viibryd, it's essential to consult your healthcare provider immediately to discuss the best course of action. Abrupt discontinuation of Viibryd can cause withdrawal symptoms, including dizziness, nausea, headache, and irritability. Some key points to consider when switching from Viibryd to an alternative medication include:

• The American College of Physicians recommends selecting second-generation antidepressants based on adverse effect profiles, cost, and patient preferences 1.
• A cross-tapering approach, gradually reducing Viibryd while introducing the new medication, is likely to be recommended by your doctor.
• Exploring cost-saving options like manufacturer patient assistance programs, GoodRx discounts, or asking your pharmacy about lower-cost alternatives can help make the new medication more affordable.
• The best alternative depends on your specific symptoms, medical history, and previous medication responses, as these medications have similar efficacy but different side effect profiles and drug interactions 1. Some alternative medications to consider, in addition to sertraline, include:
• Escitalopram (Lexapro), which costs around $10 per month as a generic and has a favorable adverse effect profile 1.
• Venlafaxine (Effexor XR), which costs around $14-30 per month as a generic and is a preferred agent with a favorable adverse effect profile 1.
• Fluoxetine (Prozac), which costs around $4-8 per month as a generic, but may have a greater risk of agitation and overstimulation 1.

From the Research

Alternative Antidepressants to Viibryd

If Viibryd is suddenly unavailable due to cost, there are other antidepressants that can be considered as alternatives. Some of these options include:

• Bupropion: a norepinephrine and dopamine reuptake inhibitor with no significant effects on serotonin concentrations 2
• Mirtazapine: a tetracyclic antidepressant that enhances norepinephrine and serotonin neurotransmission 2
• Trazodone: a 5-HT2A and 5-HT2C receptor antagonist and selective serotonin reuptake inhibitor 2
• Vortioxetine: a novel antidepressant that combines direct serotonin transporter inhibition and 5-HT1A receptor modulation 2
• Vilazodone: a selective serotonin reuptake inhibitor and 5-HT1A receptor partial agonist, although it is similar to Viibryd, it may not be a suitable alternative if Viibryd is unavailable due to cost 3, 4, 5

Comparison of Alternative Antidepressants

Each of these alternative antidepressants has a unique mechanism of action and side effect profile. For example:

• Bupropion has a risk of seizures and can cause agitation, dry mouth, and insomnia 2
• Mirtazapine can cause sedation, increased appetite, and weight gain 2
• Trazodone can cause drowsiness, dizziness, and dry mouth 2
• Vortioxetine can cause nausea, sexual dysfunction, and constipation 2
• Vilazodone has been associated with diarrhea, nausea, and headache, but has limited adverse effects on sexual function or body weight 3, 4, 5

Considerations for Switching Antidepressants

When switching from Viibryd to an alternative antidepressant, it is essential to consider the potential risks and benefits of each option. Factors to consider include:

• Efficacy: how effective is the alternative antidepressant in treating depression?
• Safety: what are the potential side effects and risks associated with the alternative antidepressant?
• Tolerability: how well can the patient tolerate the alternative antidepressant?
• Cost: what is the cost of the alternative antidepressant, and is it affordable for the patient? 2, 3, 4, 5, 6