What combination of medications is most similar to vilazodone (Vibryd)?

From the Guidelines

Vilazodone most similarly compares to a combination of an SSRI antidepressant, such as fluoxetine or sertraline, and buspirone, due to its dual mechanism of action as a selective serotonin reuptake inhibitor and a partial agonist at serotonin 5-HT1A receptors. This is based on the understanding that serotonergic function plays a key role in modulating fear, worry, and stress, as well as facilitating cognitive processing of those emotions 1. The SSRI medication class, which includes medications like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone, inhibits the presynaptic reuptake of serotonin in the brain, thereby increasing availability of serotonin at the synaptic cleft 1.

The combination of an SSRI with buspirone, a 5-HT1A receptor partial agonist, is essentially what vilazodone provides in a single medication. Key considerations for this combination include:

• The advantage of vilazodone is that it provides this combination in a single medication, typically dosed at 20-40mg once daily, rather than requiring multiple pills.
• The dual action may help reduce sexual side effects commonly associated with SSRIs while potentially offering faster onset of anxiety relief due to the 5-HT1A activity.
• Vilazodone still requires gradual titration and should be taken with food to enhance absorption, as noted in clinical practice guidelines 1.
• Patients switching from an SSRI to vilazodone should be aware that cross-tapering may be necessary to avoid discontinuation symptoms, highlighting the importance of careful management and monitoring in real-life clinical practice.

From the FDA Drug Label

The concomitant use of MAOIs and serotonergic drugs including vilazodone hydrochloride increases the risk of serotonin syndrome Concomitant use of Vilazodone hydrochloride with other serotonergic drugs (including other SSRIs, SNRIs, triptans, tricyclic antidepressants, opioids, lithium, buspirone, amphetamines, tryptophan, and St. John’s Wort) increases the risk of serotonin syndrome.

The combination of medications that most similarly compares to vilazodone is SSRIs and SNRIs, as they are also serotonergic drugs that can increase the risk of serotonin syndrome when used concomitantly with vilazodone.

• Key interactions:
  • MAOIs
  • Other SSRIs
  • SNRIs
  • Triptans
  • Tricyclic antidepressants
  • Opioids
  • Lithium
  • Buspirone
  • Amphetamines
  • Tryptophan
  • St. John’s Wort 2

From the Research

Combination of Medications Similar to Vilazodone

To find a combination of medications that most similarly compares to vilazodone, we need to consider its dual mechanism of action as a selective serotonin reuptake inhibitor (SSRI) and a 5-HT1A receptor partial agonist.

• Vilazodone's unique mechanism is proposed to decrease time to efficacy, minimize sexual side effects, and provide concomitant anxiolytic properties 3.
• A combination that mimics this action could potentially include an SSRI (such as paroxetine, fluoxetine, or citalopram) paired with a 5-HT1A receptor agonist (like buspirone) 4, 5.
• Studies have shown that vilazodone is significantly superior to placebo in treating major depressive disorder (MDD) and may have an additional advantage for treating anxiety symptoms in MDD 6.
• The efficacy of vilazodone in comparison to other antidepressants, including SSRIs, suggests that its dual mechanism may offer benefits in terms of onset of action and side effect profile 3, 7.

Potential Combinations

Potential combinations that could compare to vilazodone include:

• Paroxetine (an SSRI) and buspirone (a 5-HT1A receptor agonist) 4.
• Fluoxetine (an SSRI) and a 5-HT1A receptor agonist, though specific studies on this combination are less clear 5.
• Citalopram (an SSRI) paired with a 5-HT1A receptor agonist, considering vilazodone's comparison to citalopram in terms of serotonin output 7.

Considerations

When considering these combinations, it's crucial to evaluate the clinical usefulness, potential for rapid onset of action, and the side effect profile, especially concerning sexual side effects and anxiolytic properties 3, 6.