How to discontinue vilazodone (Selective Serotonin Reuptake Inhibitor (SSRI)) in a patient already taking 10 mg once daily?

How to Discontinue Vilazodone 10 mg Once Daily

For a patient taking vilazodone 10 mg once daily for 2.5 weeks, the medication should be tapered to discontinuation by taking 10 mg once daily for 7 days before stopping completely. 1

Discontinuation Protocol for Vilazodone

FDA-Approved Tapering Schedule

• For patients on vilazodone 10 mg once daily (the lowest therapeutic dose), the FDA recommends tapering by continuing the 10 mg once daily dose for 7 days before discontinuing 1
• For patients on higher doses (20-40 mg), more gradual tapering schedules are recommended 1

Rationale for Gradual Discontinuation

• Abrupt cessation of vilazodone can lead to discontinuation symptoms similar to other SSRIs 1
• A gradual reduction rather than abrupt cessation minimizes the risk of withdrawal symptoms 1
• Vilazodone acts as both a selective serotonin reuptake inhibitor (SSRI) and a 5-HT1A receptor partial agonist, making proper discontinuation important 2

Potential Discontinuation Symptoms

Common Symptoms to Monitor

• Patients may experience insomnia, flu-like symptoms, mood disturbances, dizziness, and paresthesias during discontinuation 3
• Gastrointestinal symptoms such as nausea and diarrhea may occur, as these are common side effects of vilazodone 4
• Symptoms can last from days to months, with different symptoms having different durations 3

Risk Factors for Discontinuation Syndrome

• Even though the patient has only been on vilazodone for 2.5 weeks, discontinuation symptoms are still possible 3
• The risk of discontinuation syndrome may be lower with shorter duration of treatment, but following the proper tapering protocol is still recommended 3

Management During Discontinuation

Monitoring and Support

• Monitor for emergence of discontinuation symptoms during the 7-day tapering period 3
• If significant discontinuation symptoms occur despite tapering, consider slowing the taper further 3
• Patient education about potential discontinuation symptoms is important for adherence and symptom recognition 3

If Discontinuation Symptoms Occur

• If severe symptoms emerge during the taper, return to the previous stable dose (10 mg daily) and consider an even more gradual taper 3
• Symptomatic management of specific discontinuation symptoms may be needed 3

Special Considerations

Short Duration of Treatment

• Since the patient has only been on vilazodone for 2.5 weeks, the risk of severe discontinuation syndrome may be lower than for long-term users 3
• However, following the FDA-recommended tapering schedule is still the safest approach 1

Medication Timing

• Vilazodone should be taken with food during the tapering period to maintain consistent absorption 1
• If a dose is missed during the tapering period, it should be taken as soon as remembered unless it's almost time for the next dose 1

By following this 7-day tapering schedule for vilazodone 10 mg, the risk of discontinuation syndrome can be minimized while ensuring patient safety and comfort during the discontinuation process.