How to Titrate Off Lexapro 15 mg and Start Vilazodone (Viibryd)
When transitioning from escitalopram (Lexapro) 15 mg to vilazodone (Viibryd), a cross-titration approach is recommended with gradual tapering of escitalopram while simultaneously initiating and titrating up vilazodone to minimize withdrawal symptoms and optimize treatment outcomes.
Discontinuation Schedule for Lexapro (Escitalopram)
Escitalopram has a half-life of 27-33 hours 1, and abrupt discontinuation can lead to withdrawal symptoms. A gradual taper is necessary:
- Week 1: Reduce escitalopram from 15 mg to 10 mg daily
- Week 2: Reduce escitalopram to 5 mg daily
- Week 3: Reduce escitalopram to 5 mg every other day
- Week 4: Discontinue escitalopram completely
Vilazodone Initiation Schedule
Vilazodone requires gradual titration to minimize gastrointestinal side effects 2, 3:
- Week 1: Start vilazodone 10 mg once daily with food
- Week 2: Increase to vilazodone 20 mg once daily with food
- Week 3: Increase to target dose of vilazodone 40 mg once daily with food
Important Considerations
Administration Requirements
- Vilazodone must be taken with food to ensure proper absorption
- Taking vilazodone without food can result in inadequate drug levels and reduced efficacy 3
Monitoring for Side Effects
- Common vilazodone side effects: Diarrhea, nausea, vomiting, and insomnia 2
- Other potential side effects: Dizziness, dry mouth, fatigue, abnormal dreams, decreased libido 2
- Most side effects are self-limited and typically resolve within 4-5 days after starting the medication 2
Timing Considerations
- Vilazodone shows improvement in depressive symptoms within 1 week of initiating therapy 2
- Full therapeutic effect is observed at 4-6 weeks 2
Potential Drug Interactions
- Vilazodone is a selective serotonin reuptake inhibitor and 5-HT1A receptor partial agonist 2
- Avoid concurrent use with MAOIs due to risk of serotonin syndrome
- Use caution with other serotonergic medications
Special Populations
- Elderly patients: Consider slower titration of both medications
- Patients with hepatic impairment: May require dose adjustments and closer monitoring
- Pregnancy/breastfeeding: Benefits must outweigh risks; discuss with patient
Potential Challenges and Solutions
- Withdrawal symptoms from escitalopram: If withdrawal symptoms occur (dizziness, nausea, headache, paresthesia), slow the taper further
- Gastrointestinal side effects from vilazodone: Emphasize the importance of taking with food to minimize these effects
- Anxiety during transition: Consider temporary use of as-needed medications for breakthrough anxiety if clinically indicated
This cross-titration approach allows for gradual adjustment of neurotransmitter systems while minimizing the risk of withdrawal symptoms or adverse effects during the transition period.