Can You Cut Vortioxetine Pills?
No specific evidence exists regarding whether vortioxetine tablets can be split or crushed, and the FDA labeling does not address tablet splitting. In the absence of explicit guidance, vortioxetine tablets should generally be taken whole as prescribed.
Pharmaceutical Considerations
Vortioxetine is formulated as oral tablets in 5 mg, 10 mg, and 20 mg strengths, administered once daily without regard to food 1. The pharmacokinetics demonstrate:
- Linear and dose-proportional absorption with 75% oral bioavailability 1
- Mean terminal half-life of approximately 66 hours 1
- Steady-state concentrations achieved within 2 weeks 1
Clinical Implications of Tablet Modification
Without manufacturer guidance on tablet splitting, several risks emerge:
- Dose accuracy cannot be guaranteed - splitting may result in unequal portions and inconsistent dosing
- Stability concerns - exposure to air and moisture after splitting may affect drug stability
- Bioavailability alterations - if tablets have special coatings, splitting could affect absorption kinetics 1
Dosing Flexibility
The availability of multiple tablet strengths (5 mg, 10 mg, 20 mg) eliminates the need for tablet splitting in most clinical scenarios 1, 2. The recommended starting dose is 10 mg once daily, with adjustments made using intact tablets 2.
Dose adjustment is only recommended for CYP2D6 poor metabolizers, where reduction from standard dosing may be necessary 1. Even in these cases, using lower-strength intact tablets is preferable to splitting.
Practical Recommendation
Prescribe the appropriate tablet strength rather than instructing patients to split tablets. If dose titration between available strengths is needed, consider:
- Using the lower available strength
- Alternating between two strengths on different days (e.g., 5 mg and 10 mg on alternate days for an average 7.5 mg dose)
- Consulting with a pharmacist about compounding options if truly intermediate doses are required
The long half-life of vortioxetine (66 hours) makes alternate-day dosing with different strengths a viable strategy for achieving intermediate doses 1.