Recommended Dosing Schedule for Trintellix (Vortioxetine)
Trintellix (vortioxetine) should be taken once daily at a recommended starting dose of 10 mg, with or without food, and then increased to 20 mg daily as tolerated. 1
Dosing Recommendations
Initial Dosing and Titration
- Start with 10 mg administered orally once daily
- Increase to 20 mg/day as tolerated after initial period
- For patients who cannot tolerate higher doses, consider 5 mg/day
- Can be taken without regard to meals (with or without food)
Special Dosing Considerations
- Maximum recommended dose is 10 mg/day in known CYP2D6 poor metabolizers
- When discontinuing treatment:
- For doses of 15-20 mg/day: Reduce to 10 mg/day for one week prior to full discontinuation
- Lower doses (5-10 mg/day): Can be discontinued abruptly
Pharmacokinetic Properties
- Linear and dose-proportional pharmacokinetics
- Mean terminal half-life of approximately 66 hours
- Steady-state plasma concentrations generally achieved within 2 weeks
- Mean absolute oral bioavailability of 75%
- No food effect on pharmacokinetics observed 2
Drug Interactions to Consider
- Strong CYP2D6 inhibitors (e.g., bupropion): Reduce Trintellix dose by half
- Strong CYP inducers (e.g., rifampin): Consider dose increase when coadministered for more than 14 days (maximum should not exceed 3 times the original dose)
- Use caution when combining with other serotonergic agents due to risk of serotonin syndrome 1
Important Safety Considerations
- Carries a boxed warning for increased risk of suicidal thoughts and behaviors in pediatric and young adult patients
- May increase risk of bleeding when used with aspirin, NSAIDs, antiplatelet drugs, or anticoagulants
- Monitor for activation of mania/hypomania, especially in patients with bipolar disorder
- May cause sexual dysfunction
- Not approved for use in pediatric patients 1
Common Side Effects
- Most common adverse reactions (≥5% and at least twice the rate of placebo):
- Nausea
- Constipation
- Vomiting 1
Remember that Trintellix has a multimodal mechanism of action targeting multiple serotonin receptors and the serotonin transporter, which distinguishes it from other antidepressants 3. The once-daily dosing schedule helps simplify treatment and potentially improve adherence.