Viibryd (Vilazodone) Titration Schedule
Start vilazodone at 10 mg once daily with food for 7 days, then increase to 20 mg once daily with food, and after a minimum of 7 additional days, may increase to the target dose of 40 mg once daily with food. 1
Standard Titration Protocol
The FDA-approved titration schedule follows a stepwise approach to minimize gastrointestinal side effects:
- Week 1 (Days 1-7): 10 mg once daily with food 1
- Week 2 onwards: 20 mg once daily with food 1
- Week 3 onwards (if needed): 40 mg once daily with food, after a minimum of 7 days at the 20 mg dose 1
The target therapeutic dose is 20-40 mg once daily. 1
Critical Administration Requirements
- Must be taken with food to ensure adequate plasma concentrations and bioavailability 1, 2, 3
- The incremental dose adjustment is necessary to minimize gastrointestinal symptoms, particularly diarrhea and nausea 1, 2
- If a dose is missed, take it as soon as remembered unless it's almost time for the next dose; never double dose 1
Dose Modifications for Drug Interactions
With Strong CYP3A4 Inhibitors:
- Do not exceed 20 mg once daily when co-administered with strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin, voriconazole) 1
- Resume original dose when the inhibitor is discontinued 1
With Strong CYP3A4 Inducers:
- Consider increasing vilazodone dose by 2-fold (up to maximum 80 mg once daily) over 1-2 weeks in patients taking strong CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin) for greater than 14 days 1
- Gradually reduce back to original dose over 1-2 weeks when the inducer is discontinued 1
Discontinuation Taper Schedule
When stopping vilazodone, gradual dose reduction is recommended rather than abrupt cessation: 1
- From 40 mg daily: Reduce to 20 mg once daily for 4 days, then 10 mg once daily for 3 days 1
- From 20 mg daily: Reduce to 10 mg once daily for 7 days 1
Common Pitfalls to Avoid
- Do not start at higher doses to avoid excessive gastrointestinal side effects (diarrhea, nausea, vomiting), which are the most common adverse events 1, 4, 2
- Do not administer without food, as this significantly reduces bioavailability and effectiveness 1, 2, 3
- Do not rush titration - maintain at least 7 days between dose increases 1
- Screen for bipolar disorder before initiating treatment, as antidepressants can precipitate manic episodes 1
- Allow at least 14 days between discontinuing MAOIs and starting vilazodone, and vice versa 1
Clinical Context
The two-week titration period up to the target dose of 40 mg is necessary due to the high rate of gastrointestinal side effects observed in clinical trials 5, 2. The efficacy of vilazodone at 40 mg daily was established in placebo-controlled trials showing significant improvement in depression scores, with some studies showing benefits as early as week 1-2 4, 2.