Trintellix (Vortioxetine) Dosing Recommendations
The recommended starting dose of Trintellix (vortioxetine) is 10 mg administered orally once daily without regard to meals, with a target dose of 20 mg/day as tolerated. 1
Standard Dosing Protocol
- Initial dose: 10 mg once daily, taken with or without food 1
- Target dose: Increase to 20 mg/day as tolerated 1
- Lower dose option: 5 mg/day may be considered for patients who do not tolerate higher doses 1
- Maximum FDA-approved dose: 20 mg/day 1
Special Population Considerations
- CYP2D6 poor metabolizers: Maximum recommended dose is 10 mg/day 1
- Patients taking strong CYP2D6 inhibitors: Reduce Trintellix dose by half when coadministered 1
- Patients taking strong CYP inducers: Consider dose increase when coadministered for more than 14 days (maximum recommended dose should not exceed 3 times the original dose) 1
Discontinuation Protocol
- Trintellix can be discontinued abruptly 1
- However, for patients on 15-20 mg/day, it is recommended to reduce the dose to 10 mg/day for one week prior to full discontinuation if possible 1
- This tapering approach may help minimize potential discontinuation symptoms, although studies show discontinuation symptoms are comparable to placebo in the first and second week after stopping 2
Clinical Efficacy
- All doses of vortioxetine (5 mg, 10 mg, and 20 mg) have demonstrated efficacy in treating major depressive disorder 3
- In relapse prevention studies, patients maintained on 5 mg, 10 mg, or 20 mg showed significantly lower relapse rates (17.4-19.3%) compared to placebo (32.5%) 3
Tolerability Considerations
- Most common adverse reactions (incidence ≥5% and at least twice the rate of placebo) are nausea, constipation, and vomiting 1
- Nausea is dose-dependent, occurring in 20.9-31.2% of patients, and is typically mild to moderate in severity 2
- Vortioxetine has a favorable side effect profile regarding sexual dysfunction (1.6-1.8% vs 1.0% for placebo) and insomnia (2.0-5.1% vs 4.0% for placebo) compared to other antidepressants 2
Clinical Pearls
- Vortioxetine has a unique mechanism of action that includes both serotonin reuptake inhibition and modulation of multiple serotonin receptors 4
- It has demonstrated procognitive effects that may benefit patients with cognitive symptoms of depression 5
- Unlike some antidepressants, vortioxetine has minimal effects on body weight, heart rate, blood pressure, or ECG parameters 2
Common Pitfalls to Avoid
- Failing to consider dose reduction in CYP2D6 poor metabolizers or patients taking CYP2D6 inhibitors 1
- Not accounting for potential drug interactions with MAOIs (contraindicated), other serotonergic agents (risk of serotonin syndrome), or medications affecting coagulation (increased bleeding risk) 1
- Overlooking the need for dose adjustment when adding or removing strong CYP inducers or inhibitors 1