How to taper off Trintellix (vortioxetine)?

Tapering Trintellix (Vortioxetine)

Trintellix should be tapered gradually with dose reductions of 5-10% every 2-4 weeks to minimize withdrawal symptoms and optimize patient outcomes.

Understanding Trintellix Pharmacology

• Trintellix (vortioxetine) is a multimodal antidepressant with a distinctive pharmacological profile that combines serotonin transporter inhibition with modulation of multiple serotonin receptors 1
• The drug has a long half-life of approximately 66 hours, with steady-state plasma concentrations generally achieved within 2 weeks of dosing 2
• This relatively long half-life may help reduce withdrawal symptoms compared to other antidepressants with shorter half-lives 2

Recommended Tapering Protocol

General Approach

• Implement slow tapering with reductions of 5-10% of the current dose every 2-4 weeks 3
• Each new dose should be approximately 90% of the previous dose rather than equal decrements from the starting dose 3
• For patients on long-term therapy, consider even slower tapers of 10% per month or less 3

Specific Steps for Trintellix Tapering

• If on 20mg daily: Reduce to 15mg daily for 2-4 weeks, then 10mg daily for 2-4 weeks, then 5mg daily for 2-4 weeks, before discontinuing 3
• If on 10mg daily: Reduce to 5mg daily for 2-4 weeks before discontinuing 3
• If on 5mg daily: Consider alternate-day dosing for 2 weeks (5mg every other day), then every third day for 2 weeks before discontinuing 3

Monitoring During Tapering

• Monitor for withdrawal symptoms after each dose reduction before proceeding to the next step 3, 4
• Common withdrawal symptoms may include nausea, dizziness, headache, and mood changes 5
• If withdrawal symptoms become severe, return to the previous well-tolerated dose and slow the taper further 3, 4

Managing Withdrawal Symptoms

• For insomnia during tapering, consider temporary use of alternative sleep aids 3
• For anxiety or irritability, short-term supportive interventions may be beneficial 3
• Never abruptly discontinue Trintellix except in cases of serious medical toxicity 4

Special Considerations

• The target dose may not necessarily be zero; some patients may benefit from continuing at a lower maintenance dose 3
• If the patient is also taking benzodiazepines, address the benzodiazepine taper first due to higher risks associated with benzodiazepine withdrawal 3
• Patients who are CYP2D6 poor metabolizers may require special attention during tapering as they have higher vortioxetine plasma concentrations 5

Common Pitfalls to Avoid

• Avoid tapering too quickly (less than 10% reduction every 2-4 weeks) 4
• Avoid setting arbitrary time limits for completing the taper 4
• Never abandon patients who are struggling with the taper; consider pausing rather than discontinuing care 4
• Be aware that suicidal thoughts and behaviors may increase during antidepressant tapering, particularly in pediatric patients 5

Follow-up and Support

• Monitor patients at least monthly during the tapering process 4
• Incorporate non-pharmacological approaches such as cognitive behavioral therapy and exercise 4
• Close monitoring and support during the tapering process are critical to success 3