Can Trintellix (vortioxetine) cause itching?

Trintellix (Vortioxetine) and Itching

Yes, Trintellix (vortioxetine) can cause itching (pruritus), which is listed as a common adverse reaction in the FDA drug label, occurring in 1-3% of patients taking the medication. 1

Evidence from the Drug Label

The FDA-approved drug label for Trintellix specifically lists pruritus (itching) as one of the common adverse reactions that occurred in ≥2% of patients treated with any Trintellix dose and at least 2% greater than the incidence in placebo-treated patients in clinical trials. According to the label:

• Pruritus (including generalized pruritus) occurred in 1% of patients taking 5 mg/day
• 2% of patients taking 10 mg/day
• 3% of patients taking 15 mg/day
• 3% of patients taking 20 mg/day
• Compared to only 1% in placebo-treated patients 1

Mechanism and Characteristics

The itching associated with Trintellix appears to be dose-related, with higher doses more likely to cause this side effect. The exact mechanism behind Trintellix-induced pruritus is not fully understood, but it may be related to the drug's effects on serotonin receptors, particularly its action as a serotonin modulator and stimulator.

Research has identified vortioxetine-induced itching as an "unlisted" adverse drug reaction with a "probable" causal relationship to the medication based on the Naranjo Scale assessment. 2

Management of Trintellix-Induced Pruritus

If a patient experiences itching while taking Trintellix, the following approach is recommended:

First-line treatments:

• Topical therapies:
  • Emollients applied regularly to maintain skin hydration 3
  • Topical moderate to high-potency corticosteroids for localized areas of itching 3
  • Moisturizers with menthol 0.5% or urea/polidocanol can provide relief 3

Second-line treatments:

• Systemic therapies (if topical treatments are insufficient):
  • Non-sedating antihistamines such as fexofenadine 180mg, loratadine 10mg, or cetirizine 10mg daily 3
  • For severe cases, consider combining H1 and H2 antagonists (e.g., fexofenadine and cimetidine) 3

When to consider dose adjustment or discontinuation:

• If itching is severe or significantly impacts quality of life
• If symptoms persist despite appropriate management
• If other concerning symptoms develop alongside the pruritus

Important Considerations

1. Differential diagnosis: Rule out other causes of itching, including other medications, skin conditions, or systemic diseases.

2. Monitoring: Assess the severity and distribution of itching, and monitor for any signs of rash or other skin reactions that could indicate a more serious hypersensitivity reaction.

3. Risk factors: Female patients may be more susceptible to adverse reactions with Trintellix in general, though specific gender differences for pruritus are not well-established. 1

4. Benefit-risk assessment: For most patients with mild to moderate itching, the benefits of continuing Trintellix for depression treatment may outweigh the discomfort of pruritus, especially if it can be managed with topical treatments.

5. Caution: If severe itching occurs or if accompanied by signs of a serious allergic reaction (such as swelling, difficulty breathing, or widespread rash), immediate medical attention should be sought as this could represent a hypersensitivity reaction rather than simple pruritus. 1

In conclusion, itching is a recognized side effect of Trintellix that occurs in a small but significant percentage of patients. Most cases can be managed with topical treatments and antihistamines while continuing the medication, but severe cases may require dose adjustment or discontinuation.