Recommended Starting Dose for Trintellix (Vortioxetine)
The recommended starting dose for Trintellix (vortioxetine) is 10 mg administered orally once daily without regard to meals. 1
Dosing Guidelines
- The initial dose of 10 mg once daily should be increased to 20 mg/day as tolerated 1
- For patients who do not tolerate higher doses, a lower dose of 5 mg/day can be considered 1
- Trintellix can be taken without regard to food as no food effect on pharmacokinetics has been observed 2
- The medication has a mean terminal half-life of approximately 66 hours, with steady-state plasma concentrations generally achieved within 2 weeks of dosing 2
Special Population Considerations
- For patients who are known CYP2D6 poor metabolizers, the maximum recommended dose is 10 mg/day 1
- No dose adjustment is needed based on age, gender, or the presence of renal or mild to moderate hepatic impairment 3
- When co-administered with strong CYP2D6 inhibitors (such as bupropion), the Trintellix dose should be reduced by half 1
Titration and Maintenance
- After starting at 10 mg/day, if well tolerated, the dose can be increased to the target dose of 20 mg/day 4
- Some clinical trials have demonstrated that early up-titration to 20 mg/day (after 1 week) can be achieved without compromising tolerability 4
- For discontinuation, doses of 15 mg/day or 20 mg/day should be reduced to 10 mg/day for one week prior to full discontinuation to avoid potential withdrawal symptoms 1
Efficacy Considerations
- Clinical trials have shown that 20 mg/day was the effective dose in US studies, while lower doses (5-10 mg/day) were effective in non-US maintenance studies 3
- Vortioxetine has demonstrated effectiveness in reducing symptoms of both depression and anxiety in patients with major depressive disorder 4, 5
- The medication has also shown positive effects on cognitive symptoms of major depressive episodes 5
Adverse Effects
- The most common adverse event is nausea, which is dose-dependent 3
- Other common adverse reactions (incidence ≥5% and at least twice the rate of placebo) include constipation and vomiting 1
- Vortioxetine's adverse event profile is generally similar to that of other selective serotonin reuptake inhibitors (SSRIs) 3
By following these dosing recommendations, clinicians can optimize the therapeutic benefits of Trintellix while minimizing potential adverse effects.