What are the considerations for using Trintellix (vortioxetine) in patients with a history of eye problems?

Trintellix (Vortioxetine) and Eye Problems

Patients with a history of eye problems should be monitored for potential angle-closure glaucoma when using Trintellix, as the medication can cause mild pupillary dilation which may trigger acute angle-closure glaucoma in susceptible individuals. 1

Risk of Angle-Closure Glaucoma

Trintellix (vortioxetine) carries a specific warning regarding potential eye-related side effects. According to the FDA drug label, Trintellix can cause mild pupillary dilation, which in susceptible individuals may lead to an episode of angle-closure glaucoma 1. This is particularly important for patients who already have eye problems or risk factors for glaucoma.

Key considerations:

• Pre-existing glaucoma is almost always open-angle glaucoma, which is not a risk factor for angle-closure glaucoma
• Patients with anatomically narrow angles may be at higher risk
• Angle-closure glaucoma, when diagnosed, can be treated definitively with iridectomy 1

Recommendations for Patients with Eye Problems

1. Pre-treatment evaluation:

   • Patients with a history of eye problems, particularly those with narrow anterior chamber angles, should have a baseline ophthalmic examination before starting Trintellix
   • Patients with diabetes, uveitis, or history of macular edema should have a comprehensive ophthalmic examination of the fundus (including the macula) before initiating treatment 2

2. During treatment monitoring:

   • Monitor for changes in vision or symptoms of macular edema (blurriness, blind spot, shadows in center of vision, sensitivity to light, unusually colored vision) 2
   • Patients with a history of diabetes, uveitis, or macular edema should have regular ophthalmic examinations while on Trintellix 2
   • Patients should be instructed to report any visual changes immediately to their healthcare provider 1

3. Patient education:

   • Inform patients about potential eye-related side effects
   • Advise patients to seek immediate medical attention if they experience eye pain, changes in vision, or swelling/redness around the eye 1
   • Patients may wish to be examined to determine whether they are susceptible to angle closure and have a prophylactic procedure (e.g., iridectomy) if they are susceptible 1

Other Important Considerations with Trintellix

While eye problems are a specific concern, other important considerations when using Trintellix include:

• Serotonin syndrome risk: Particularly with concomitant use of other serotonergic drugs including triptans, tricyclic antidepressants, opioids, lithium, tryptophan supplements, busipirone, and St. John's Wort 1

• Bleeding risk: Increased risk of bleeding when used with NSAIDs, aspirin, warfarin, or other drugs affecting coagulation 1

• Discontinuation effects: Patients should not abruptly stop taking Trintellix without consulting their healthcare provider 1

• Hyponatremia risk: Patients who are elderly, treated with diuretics, or volume depleted may be at greater risk of developing hyponatremia 1

Conclusion

For patients with a history of eye problems, Trintellix can be used with appropriate monitoring and precautions. The most significant eye-related concern is the potential for angle-closure glaucoma in susceptible individuals. A baseline ophthalmic examination may be warranted in patients with pre-existing eye conditions, and all patients should be educated about reporting visual symptoms promptly.