Trintellix (Vortioxetine) Dosing Recommendations
The recommended starting dose of Trintellix (vortioxetine) is 10 mg administered orally once daily without regard to meals, with a recommended increase to 20 mg/day as tolerated. 1
Standard Dosing Protocol
- Initial dose: 10 mg once daily orally without regard to meals 1
- Target dose: Increase to 20 mg/day as tolerated 1
- Lower dose option: 5 mg/day for patients who do not tolerate higher doses 1
- Administration timing: Can be taken at any time of day, with or without food 1
Special Population Considerations
- CYP2D6 poor metabolizers: Maximum recommended dose is 10 mg/day 1
- Patients taking strong CYP2D6 inhibitors (e.g., bupropion): Reduce Trintellix dose by half 1
- Patients taking strong CYP inducers (e.g., rifampin): Consider dose increase when coadministered for more than 14 days. Maximum dose should not exceed 3 times the original dose 1
Dose Titration and Optimization
- Early dose optimization: Research supports increasing vortioxetine dosage to 20 mg/day early in therapy for optimal effectiveness 2
- Dose titration can be achieved without compromising tolerability in most patients 2
- For patients with comorbid anxiety and depression, the 20 mg dose may be particularly beneficial 2
Discontinuation Protocol
- Trintellix can be discontinued abruptly 1
- However, for doses of 15 mg/day or 20 mg/day, it is recommended to reduce to 10 mg/day for one week prior to full discontinuation if possible 1
Treatment Duration
- For maintenance therapy in patients with recurrent major depressive disorder, continued treatment at the effective dose has been shown to significantly reduce relapse rates compared to placebo 3
- All doses (5 mg, 10 mg, and 20 mg) have demonstrated effectiveness in relapse prevention 3
Pharmacokinetic Considerations
- Linear and dose-proportional pharmacokinetics 4
- Mean terminal half-life of approximately 66 hours 4
- Steady-state plasma concentrations generally achieved within 2 weeks of dosing 4
- Mean absolute oral bioavailability of 75% 4
- No food effect on pharmacokinetics 4
Common Pitfalls and Caveats
- Nausea management: Nausea is one of the most common side effects. Taking the medication with food may help reduce this side effect, even though food does not affect absorption 1, 5
- Serotonin syndrome risk: Increased risk when coadministered with other serotonergic agents. Monitor for symptoms and discontinue if serotonin syndrome occurs 1
- Bleeding risk: Concomitant use with aspirin, NSAIDs, antiplatelet drugs, or anticoagulants may increase bleeding risk 1
- Activation of mania/hypomania: Screen patients for bipolar disorder before initiating treatment 1
Treatment-Resistant Depression
- For treatment-resistant depression, some studies have explored supratherapeutic doses (30-40 mg/day), which showed effectiveness and relative tolerability, though these doses exceed FDA-approved recommendations 6
- Such doses should only be considered in specialized settings with close monitoring and are not part of standard care 6