What is the recommended protocol for discontinuing Trintellix (vortioxetine)?

Trintellix (Vortioxetine) Discontinuation Protocol

While Trintellix can be abruptly discontinued, it is recommended to taper the dose to 10 mg/day for one week before full discontinuation of doses of 15 mg/day or 20 mg/day to minimize withdrawal symptoms. 1

FDA-Recommended Discontinuation Protocol

• According to the FDA drug label, although Trintellix can be abruptly discontinued, patients in clinical trials experienced transient adverse reactions such as headache and muscle tension following abrupt discontinuation of higher doses 1
• For patients on 15 mg/day or 20 mg/day, reduce to 10 mg/day for one week before complete discontinuation 1
• For patients on 10 mg/day or lower doses, the medication can be discontinued without tapering, though a gradual approach may still be beneficial 1

Potential Discontinuation Symptoms

• Common discontinuation symptoms that may occur include:
  • Headache and muscle tension (specifically noted in Trintellix clinical trials) 1
  • Dizziness, fatigue, nausea, sensory disturbances, and sleep disturbances 2
  • Psychological symptoms such as anxiety, irritability, and mood changes 2

Extended Tapering Considerations

• For patients who experience significant discontinuation symptoms with the standard one-week taper, consider:
  • A more gradual taper over several weeks to months, especially for patients who have been on long-term treatment 3, 4
  • Hyperbolic tapering (making smaller reductions as the dose gets lower) may be more effective than linear tapering for minimizing withdrawal symptoms 3
  • For severe withdrawal symptoms, temporarily reinstating the previous dose and then tapering more slowly 4

Special Considerations

• Monitor patients closely during the discontinuation period for:
  • Emergence of discontinuation symptoms 2
  • Potential relapse of depression, which should be differentiated from withdrawal symptoms 2, 4
  • Suicidal thoughts and behaviors, especially in young adults, as antidepressant discontinuation can be a vulnerable period 1

Common Pitfalls to Avoid

• Mistaking withdrawal symptoms for relapse of depression, which could lead to unnecessary reinstatement of medication or increased dosing 2, 3
• Tapering too quickly, which increases risk of discontinuation symptoms 3, 4
• Failing to educate patients about potential withdrawal symptoms, which can lead to anxiety and poor adherence to the discontinuation plan 2
• Not having a monitoring plan in place during and after discontinuation 4

Practical Implementation

• Schedule follow-up appointments during the tapering period to assess for withdrawal symptoms and provide support 4
• Educate patients about the difference between withdrawal symptoms and depression relapse 2
• Consider adjunctive supportive interventions during discontinuation, such as psychotherapy, to manage anxiety about discontinuation 4
• For patients with severe or persistent discontinuation symptoms, consider consulting with a psychiatrist for specialized management 4