How should vilazodone (a selective serotonin reuptake inhibitor) be discontinued after a dose of 10 mg over 2.5 weeks?

Discontinuation Protocol for Vilazodone After 10 mg for 2.5 Weeks

Vilazodone should be tapered to 10 mg once daily for 7 days before discontinuation to minimize withdrawal symptoms. 1

Recommended Discontinuation Protocol

For a patient who has been taking vilazodone 10 mg for 2.5 weeks:

• Since the patient is already at the lowest available dose (10 mg), continue this dose once daily for 7 days and then discontinue 1
• Take medication with food during the tapering period to ensure adequate plasma concentrations 1
• Monitor for discontinuation symptoms during and after the tapering period 1

Rationale for Tapering

• Abrupt discontinuation of SSRIs like vilazodone can lead to discontinuation syndrome 2
• The FDA-approved drug label specifically recommends gradual reduction rather than abrupt cessation to minimize adverse reactions upon discontinuation 1
• Even at the lowest dose (10 mg), a 7-day tapering period is recommended before complete discontinuation 1

Potential Discontinuation Symptoms

Discontinuation syndrome may include:

• Dizziness, fatigue, lethargy, general malaise 2
• Myalgias, chills, headaches 2
• Gastrointestinal symptoms (nausea, vomiting, diarrhea) 2
• Sleep disturbances (insomnia) 2
• Sensory disturbances, paresthesias 2
• Psychological symptoms (anxiety, irritability, agitation) 2

Special Considerations

• Even though the treatment duration has been relatively short (2.5 weeks), tapering is still recommended as discontinuation symptoms can occur even with brief treatment periods 1
• If discontinuation symptoms emerge despite tapering, consider resuming the previous dose temporarily and then tapering more gradually 2
• The risk of serotonin syndrome persists during the discontinuation period, so avoid starting any other serotonergic medications during this time 2

Clinical Monitoring During Discontinuation

• Monitor for clinical worsening of depression and emergence of suicidal thoughts during the tapering period 1
• Assess for signs of discontinuation syndrome at follow-up appointments 2
• Educate the patient about potential discontinuation symptoms and when to seek medical attention 2

Common Pitfalls to Avoid

• Avoid abrupt discontinuation even at the lowest dose of 10 mg, as this increases the risk of discontinuation syndrome 1
• Do not start another serotonergic medication immediately after discontinuation without an appropriate washout period (at least 14 days after stopping vilazodone) 1
• Do not overlook the importance of taking vilazodone with food during the tapering period, as inadequate plasma concentrations may exacerbate discontinuation symptoms 1