No - Do Not Start Auvelity Yet
The patient must wait at least 14 days after completely stopping Trintellix before starting Auvelity, as both medications affect serotonergic pathways and Auvelity contains bupropion which can interact with other antidepressants. 1
Critical Safety Concern: Washout Period Required
The FDA label for Auvelity explicitly states contraindications and warnings about combining it with other serotonergic medications. While the label specifically mentions MAOIs requiring a 14-day washout, the broader concern is serotonin syndrome risk when combining medications that affect serotonin transmission 1.
Why This Matters:
- Trintellix (vortioxetine) is a multimodal antidepressant that modulates serotonin through multiple mechanisms (5-HT3 antagonism, 5-HT1A agonism, SERT inhibition)
- Auvelity contains bupropion, and the FDA label warns about combining with "medicines used to treat mood, anxiety, psychotic or thought disorders, including selective serotonin reuptake inhibitors (SSRIs)" 1
- Vortioxetine has a terminal half-life of approximately 66 hours (about 2.75 days), meaning it takes roughly 13-14 days to be fully eliminated from the system (5 half-lives) 2
Recommended Approach:
- Complete discontinuation of Trintellix: The patient has only been at 10mg for 1 week - this is still an active dose, not fully discontinued
- Full washout period: Wait 14 days after the last dose of Trintellix before initiating Auvelity
- Monitor during washout: Watch for withdrawal symptoms (dizziness, irritability, mood changes) during the taper-off period
Additional Drug Interaction Consideration:
There is a documented pharmacokinetic interaction between vortioxetine and bupropion. When co-administered, bupropion (a CYP2D6 inhibitor) increases vortioxetine exposure by approximately 128% for AUC 3, 2. While this interaction was studied for concurrent use, starting Auvelity before Trintellix is fully cleared could result in unexpectedly high vortioxetine levels still circulating, potentially increasing adverse effects.
Common Pitfall to Avoid:
Do not confuse "tapered to 10mg" with "discontinued." The patient is still taking an active therapeutic dose of Trintellix. The 14-day washout clock starts after the final dose is taken, not when tapering begins.