How to safely discontinue Trintellix (vortioxetine)?

How to Safely Discontinue Trintellix (Vortioxetine)

Trintellix can be discontinued abruptly according to the FDA label; however, it is recommended to reduce doses of 15 mg/day or 20 mg/day to 10 mg/day for one week prior to full discontinuation to minimize withdrawal symptoms. 1

Recommended Discontinuation Protocol

• According to the FDA label, Trintellix (vortioxetine) can technically be discontinued abruptly, but a gradual approach is preferred, especially for higher doses 1
• For patients on 15 mg/day or 20 mg/day, reduce the dose to 10 mg/day for one week before complete discontinuation 1
• For patients on 10 mg/day or less, discontinuation can potentially be done without tapering, though a gradual approach may still be beneficial 1
• Implement a slower taper for patients who have been on Trintellix for longer periods (months to years) to minimize discontinuation symptoms 2

Potential Discontinuation Symptoms

• Vortioxetine discontinuation symptoms typically emerge around 3 days after stopping the medication and may last for approximately 7 days 3
• Common discontinuation symptoms include emotional lability (100% of affected patients), irritability (75%), sudden worsening of mood (75%), nervousness (37.5%), and agitation (37.5%) 3
• Other potential symptoms may include insomnia, flu-like symptoms, dizziness, and paresthesias 2
• Discontinuation symptoms are significantly more common after accidental versus planned discontinuation 3

Monitoring During Discontinuation

• Schedule follow-up appointments during the tapering period to assess for emergence of discontinuation symptoms or depression relapse 4
• Be aware that discontinuation symptoms may be mistaken for relapse of depression; however, discontinuation symptoms typically emerge within days of dose reduction and tend to be transient 5
• For mild discontinuation symptoms, reassurance about their transient nature may be sufficient 6
• For severe symptoms, consider returning to the previous dose and implementing an even slower taper 2

Special Considerations

• Patients who discontinue therapy without medical consultation are at higher risk for discontinuation symptoms 3
• If switching to another antidepressant rather than stopping treatment completely, discontinuation symptoms are less likely to occur 3
• Consider that patients who have been on antidepressants long-term have a higher risk of relapse when discontinuing; in a study of primary care patients, 56% of those who discontinued antidepressants relapsed within 52 weeks compared to 39% who maintained therapy 7

Common Pitfalls to Avoid

• Avoid abrupt discontinuation without a taper plan, especially for patients on higher doses or with longer treatment duration 2
• Do not mistake discontinuation symptoms for relapse of depression, which could lead to unnecessary reinstatement of full-dose treatment 6
• Avoid "cold referrals" to other providers without ensuring continuity of care during the discontinuation process 4
• Never abandon patients during the discontinuation process; ensure adequate support and monitoring 4