From the Guidelines
Weaning off vilazodone can be challenging for some patients, and a gradual tapering schedule is recommended to minimize discontinuation symptoms. Discontinuation symptoms may occur when stopping this antidepressant, especially if stopped abruptly. Common withdrawal symptoms include dizziness, headache, nausea, irritability, and "brain zaps" (electric shock-like sensations) [ 1 ]. To minimize these effects, a gradual tapering schedule is recommended, typically reducing the dose by 5-10 mg every 1-2 weeks under medical supervision. For example, someone on 20 mg daily might reduce to 10 mg for 1-2 weeks, then 5 mg for 1-2 weeks before stopping completely. The tapering schedule should be individualized based on the patient's current dose, duration of treatment, and personal sensitivity to medication changes.
Some key points to consider when weaning off vilazodone include:
- The difficulty in discontinuation relates to vilazodone's effects on serotonin and its relatively short half-life of about 25 hours, which can lead to more noticeable fluctuations when dosing changes [ 1 ].
- Patients should never stop vilazodone suddenly without medical guidance.
- Some patients may require an even slower taper if they experience significant discontinuation symptoms.
- Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy [ 1 ].
- Clinicians should modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder [ 1 ].
From the FDA Drug Label
Discontinuation Syndrome Advise patients not to abruptly discontinue vilazodone hydrochloride tablets and to discuss any tapering regimen with their healthcare provider. Adverse reactions can occur when vilazodone hydrochloride tablets are discontinued[see Warnings and Precautions (5. 5 )].
It may be challenging for patients to wean off of vilazodone, as discontinuation syndrome can occur if the medication is stopped abruptly. Patients should be advised to discuss a tapering regimen with their healthcare provider to minimize the risk of adverse reactions 2.
From the Research
Weaning Off Vilazodone
- The process of weaning off vilazodone is not explicitly discussed in the provided studies, but information about its discontinuation can be found in the studies 3, 4, 5, 6, 7.
- According to the study 3, gradual discontinuation of vilazodone is recommended to avoid discontinuation syndrome, but the specific details of the weaning process are not provided.
- The study 4 mentions that vilazodone requires dose titration up to 2 weeks to reach a target dose of 40 mg/d due to a high rate of gastrointestinal side effects, but it does not discuss the weaning process.
- The studies 5, 6, 7 do not provide information about weaning off vilazodone.
Discontinuation Symptoms
- The study 3 mentions that diarrhea, nausea, and headache were the most common adverse events (AEs) associated with vilazodone, but it does not specifically discuss discontinuation symptoms.
- The study 5 reports that the number needed to harm (NNH) for discontinuation due to an adverse event was 27, but it does not provide details about the specific symptoms experienced during discontinuation.
- The study 7 mentions that the adverse effects most commonly reported in clinical trials of vilazodone were diarrhea, nausea, vomiting, and insomnia, but it does not discuss discontinuation symptoms.
Clinical Recommendations
- Based on the available information, it is recommended that patients follow a gradual discontinuation schedule to minimize the risk of discontinuation syndrome when stopping vilazodone, as mentioned in the study 3.
- However, the specific details of the weaning process are not provided in the studies, and healthcare professionals should consult the prescribing information and clinical guidelines for guidance on discontinuing vilazodone 3, 4, 5, 6, 7.