What is the recommended protocol for tapering Viibryd (vilazodone)?

Tapering Protocol for Vilazodone (Viibryd)

Vilazodone should be tapered gradually by reducing from 40 mg once daily to 20 mg once daily for 4 days, followed by 10 mg once daily for 3 days. For patients taking 20 mg once daily, taper to 10 mg once daily for 7 days. 1

FDA-Approved Tapering Schedule

The FDA-approved drug label for vilazodone provides specific guidance for discontinuation:

• For patients on 40 mg daily:

  • Step 1: Reduce to 20 mg once daily for 4 days
  • Step 2: Further reduce to 10 mg once daily for 3 days
  • Step 3: Discontinue completely

• For patients on 20 mg daily:

  • Step 1: Reduce to 10 mg once daily for 7 days
  • Step 2: Discontinue completely

This tapering schedule is designed to minimize withdrawal symptoms that may occur upon discontinuation of vilazodone 1.

Rationale for Gradual Tapering

Abrupt discontinuation of antidepressants like vilazodone can lead to withdrawal symptoms, which may include:

• Anxiety
• Irritability
• Insomnia
• Dizziness
• Sensory disturbances (e.g., electric shock sensations)
• Gastrointestinal symptoms

Research indicates that all classes of antidepressants, including SSRIs like vilazodone, are associated with withdrawal syndromes that can be severe and might compel patients to restart their medication 2. Vilazodone functions as both an SSRI and a 5-HT1A receptor agonist, which means its discontinuation should be managed carefully 3.

Alternative Tapering Approaches for Difficult Cases

While the FDA-approved schedule is recommended for most patients, those experiencing significant withdrawal symptoms despite following the standard taper may benefit from more gradual approaches:

1. Hyperbolic Tapering: Research suggests that hyperbolically reducing doses (making smaller reductions as the dose gets lower) may be more effective in minimizing withdrawal symptoms 4. This approach reduces the biological effect at receptors by fixed amounts.

2. Extended Tapering: For patients who experience severe withdrawal symptoms with the standard taper, extending the duration between dose reductions to 3-6 months may be beneficial 5.

3. Very Small Final Doses: Some research suggests that final doses before complete cessation may need to be very small (as low as 1/40th of a therapeutic dose) to prevent a large decrease in neurotransmitter effects when stopped 5.

Monitoring During Tapering

During the tapering process, monitor for:

• Emergence or worsening of withdrawal symptoms
• Recurrence of depressive symptoms (which can be distinguished from withdrawal)
• Suicidal thoughts or behaviors, especially in young adults 1

Important Considerations

• Vilazodone should be taken with food to optimize bioavailability, including during the tapering period 3
• If severe withdrawal symptoms occur, consider returning to the previous dose and tapering more gradually 6
• Distinguish between withdrawal symptoms (which typically emerge within days of dose reduction and are transient) and recurrence of depression (which typically develops more gradually and persists)

Conclusion

Following the FDA-approved tapering schedule is the recommended approach for discontinuing vilazodone. For patients experiencing significant withdrawal symptoms, more gradual tapering may be necessary, potentially using hyperbolic reduction methods that have shown promise in research on antidepressant discontinuation.