From the Guidelines
The recommended protocol for switching from Lexapro (escitalopram) to Viibryd (vilazodone) involves a cross-taper approach, starting with a reduction of Lexapro by 50% while initiating Viibryd at a low dose, to minimize the risk of serotonin syndrome and withdrawal symptoms, as suggested by the cautious approach to combining serotonergic drugs 1. When switching from Lexapro to Viibryd, it's crucial to consider the potential for drug interactions and the risk of serotonin syndrome, especially when combining serotonergic drugs 1.
- Begin by reducing your Lexapro dose by 50% to minimize withdrawal symptoms.
- Start Viibryd at a low dose, 10 mg daily, for 7 days to allow your body to adjust to the new medication.
- Then, further reduce Lexapro to 5 mg (or by half again if on a different dose) while increasing Viibryd to 20 mg daily for 7 days.
- Finally, discontinue Lexapro completely while increasing Viibryd to the target dose of 40 mg daily. This gradual transition is essential to maintain stable serotonin levels in the brain and avoid both withdrawal symptoms and serotonin syndrome, as cautioned against in the management of serotonergic medications 1. Key considerations during this transition include:
- Taking Viibryd with food to improve absorption and reduce gastrointestinal side effects.
- Monitoring for temporary side effects such as dizziness, headache, nausea, or sleep disturbances.
- Consulting your healthcare provider to customize this approach based on your specific medical history and response to medication, given the importance of medical education, training, and experience in safely prescribing antidepressant medications 1.
From the Research
Switching from Lexapro to Viibryd
To switch from Lexapro (escitalopram) to Viibryd (vilazodone), the following steps can be considered:
- Gradually taper the dose of Lexapro to minimize the risk of withdrawal symptoms and serotonin syndrome 2
- After tapering Lexapro, an adequate washout period may be necessary before starting Viibryd, although the exact duration is not specified in the available studies
- Viibryd should be started at a low dose and gradually increased to the recommended dose of 40 mg daily, taken with food to optimize bioavailability 3, 4
- It is essential to monitor the patient closely during the switching process to minimize the risk of adverse events and ensure a smooth transition
Considerations for Switching
When switching from Lexapro to Viibryd, the following considerations should be taken into account:
- Vilazodone has a narrow therapeutic dosing range, and the upper boundary is close to that producing intolerable gastrointestinal and central nervous system adverse events 3
- The patient's age, gender, and renal or hepatic impairment do not require dose adjustments for vilazodone 4
- Vilazodone should be taken with food to ensure adequate plasma concentrations, and the dose may need to be reduced to 20 mg when taken with strong cytochrome P450 (CYP) 3A4 inhibitors 4
Adverse Events and Interactions
The adverse event profile of vilazodone is similar to that of selective serotonin reuptake inhibitors, and common adverse events include diarrhea, nausea, and headache 5