What is Trintellix (vortioxetine)?

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Trintellix (Vortioxetine): A Multimodal Antidepressant

Trintellix (vortioxetine) is a novel antidepressant medication with a unique multimodal mechanism of action used primarily to treat Major Depressive Disorder (MDD) in adults, with distinctive benefits for cognitive function beyond typical antidepressant effects.

Mechanism of Action

Trintellix has a distinctive pharmacological profile that differentiates it from other antidepressants:

  • Acts as a serotonin transporter (SERT) inhibitor with high affinity (Ki=1.6 nM) 1
  • Modulates multiple serotonin receptors simultaneously 1, 2:
    • 5-HT3 receptor antagonist
    • 5-HT1A receptor agonist
    • 5-HT7 receptor antagonist
    • 5-HT1B receptor partial agonist
    • 5-HT1D receptor antagonist

This multimodal mechanism is thought to contribute to both its antidepressant efficacy and its cognitive-enhancing properties 2.

Clinical Uses

Trintellix is FDA-approved for:

  • Treatment of Major Depressive Disorder (MDD) in adults 1
  • Not approved for use in children 1

Dosing Information

  • Available in tablet form in three strengths: 5 mg, 10 mg, and 20 mg 1
  • Recommended starting dose: 10 mg once daily 1
  • Dose range: 5-20 mg once daily 1
  • Can be taken with or without food 1, 3
  • Dose adjustments:
    • CYP2D6 poor metabolizers: reduced dosage recommended 1
    • No dose adjustment needed based on age, sex, race, or body size 3

Unique Benefits

What distinguishes Trintellix from other antidepressants:

  • Cognitive enhancement: Significantly improves cognitive function in MDD patients, particularly executive function, attention, processing speed, learning, and memory 4, 5
  • These cognitive benefits appear largely independent of its antidepressant effects 4
  • Demonstrated improvement in both objective cognitive measures and subjective cognitive function 4

Side Effects

Common side effects include:

  • Nausea (most common, dose-related, typically occurs in first week) 1
  • Diarrhea
  • Dizziness
  • Headache
  • Sexual dysfunction 1
  • Vomiting
  • Constipation

Important Warnings and Precautions

  • Suicidality: Increased risk of suicidal thoughts and actions in patients under 24 years 1
  • Serotonin Syndrome: Risk increases when combined with other serotonergic drugs 1
  • MAOI Interaction: Do not use within 14 days of MAOI use 1
  • Hyponatremia: Higher risk in elderly, those on diuretics, or volume-depleted patients 1
  • Sexual Dysfunction: May cause symptoms of sexual dysfunction in both males and females 1
  • Pregnancy: May cause withdrawal symptoms in newborns or persistent pulmonary hypertension 1

Drug Interactions

  • MAOIs: Contraindicated within 14 days of MAOI use 1
  • Bupropion: Strong CYP2D6 inhibitor, may increase vortioxetine exposure 3
  • Rifampin: Broad CYP450 inducer, may decrease vortioxetine exposure 3
  • Other serotonergic drugs: Increased risk of serotonin syndrome 1

Comparative Efficacy

  • As effective as venlafaxine in treating MDD 5
  • More effective than agomelatine in treating MDD as a second-line treatment 6
  • May be beneficial in overcoming sexual dysfunction in patients who experienced it with other antidepressants 5

Pharmacokinetics

  • Linear and dose-proportional pharmacokinetics 3
  • Mean terminal half-life: approximately 66 hours 3
  • Steady-state plasma concentrations achieved within 2 weeks 3
  • Absolute oral bioavailability: 75% 3
  • Metabolized primarily by CYP450 enzymes (particularly CYP2D6) 3

Trintellix represents an important treatment option for adults with MDD, particularly those experiencing cognitive dysfunction as part of their depressive symptoms.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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