Side Effects of Vortioxetine
Nausea and vomiting are the most common side effects of vortioxetine, with nausea being the primary reason for discontinuation of the medication. 1
Common Side Effects
Vortioxetine causes several common adverse effects that patients should be aware of:
Gastrointestinal effects:
- Nausea (most common)
- Vomiting
- Constipation
- Diarrhea
- Abdominal discomfort
Neurological effects:
- Dizziness
- Headache
- Insomnia
- Somnolence
Other common effects:
- Sexual dysfunction (particularly at higher doses)
- Decreased appetite
- Weight loss
- Dry mouth
Nausea typically occurs within the first week of treatment and then decreases in frequency, though it may persist in some patients 1. The gastrointestinal side effects are dose-related, meaning they tend to increase in frequency and severity at higher doses.
Serious Adverse Effects
While less common, vortioxetine may cause several serious adverse effects:
Suicidal thoughts and behavior: Like other antidepressants, vortioxetine carries an increased risk of suicidal thoughts and behaviors, particularly in young adults under 24 years of age 1.
Serotonin syndrome: Can occur, especially when combined with other serotonergic medications. Symptoms include tremor, diarrhea, delirium, neuromuscular rigidity, and hyperthermia 2.
Abnormal bleeding: Risk may be increased, particularly when used with medications that affect coagulation 2.
Hyponatremia: Elderly patients may be at greater risk for developing low sodium levels 1.
Activation of mania/hypomania: In patients with bipolar disorder or a history of mania 1.
Angle closure glaucoma: May cause mild pupillary dilation that could trigger an episode in susceptible individuals 1.
Comparison to Other Antidepressants
Vortioxetine has some distinguishing features in its side effect profile compared to other antidepressants:
Sexual dysfunction: May occur at higher doses but appears to have a lower incidence compared to many SSRIs 3.
Sedation: Lower risk of sedation compared to some other antidepressants 4.
Weight gain: Lower risk of weight gain compared to some antidepressants like mirtazapine 3, 4.
Cognitive effects: Unlike some antidepressants that may impair cognition, vortioxetine has been associated with potential positive effects on cognitive function 4, 5.
Special Populations
Elderly patients: No dose adjustment is typically needed based on age alone. However, elderly patients may be at greater risk for hyponatremia 1.
Poor CYP2D6 metabolizers: Dosage reduction is recommended as these patients have higher vortioxetine plasma concentrations 1.
Pregnancy: May cause withdrawal symptoms in newborns or persistent pulmonary hypertension of the newborn (PPHN). Animal studies showed developmental delays at higher doses 1.
Discontinuation Effects
Patients should not abruptly stop taking vortioxetine without consulting their healthcare provider, as discontinuation effects may occur. A gradual tapering is recommended to minimize these effects 1.
Monitoring Recommendations
- Monitor for emergence of suicidal thoughts, especially during initial treatment or dose changes
- Watch for signs of serotonin syndrome when combining with other serotonergic medications
- Monitor for signs of hyponatremia, particularly in elderly patients
- Assess for sexual dysfunction, which may be underreported
- Monitor for bleeding risk, especially if combined with anticoagulants or antiplatelet drugs
Understanding these side effects is crucial for both healthcare providers and patients to make informed decisions about treatment and to manage adverse effects appropriately when they occur.