What is the recommended dosing for vortioxetine (Brintellix) in patients with impaired renal function?

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Vortioxetine Dosing in Renal Impairment

No dose adjustment of vortioxetine is required for patients with impaired renal function, regardless of severity. 1

Standard Dosing Regimen

  • Start at 10 mg once daily without regard to food, then increase to 20 mg daily if the 10 mg dose is tolerated 2
  • For patients who cannot tolerate 20 mg daily, use 10 mg daily, or consider 5 mg daily as the minimum dose 2
  • The therapeutic dose range is 5-20 mg once daily 2, 3

Renal Function Does Not Affect Vortioxetine Exposure

  • Pharmacokinetic studies demonstrated no clinically meaningful differences in vortioxetine exposure (AUC and Cmax) among subjects with varying degrees of renal impairment compared to those with normal renal function 1
  • Clinically meaningful differences were defined as exposure changes between 50% and 2-fold, and renal impairment did not meet this threshold 1
  • The 90% confidence intervals for exposure ratios remained within acceptable limits across all degrees of renal dysfunction 1

Metabolism and Elimination Considerations

  • Vortioxetine is a medium-clearance drug that undergoes extensive hepatic metabolism via multiple cytochrome P450 isozymes, not renal elimination 1, 3
  • The major metabolite is pharmacologically inactive, and renal excretion plays a minimal role in drug clearance 3
  • This metabolic profile explains why renal impairment does not significantly impact vortioxetine pharmacokinetics 3

Discontinuation Guidance

  • Vortioxetine can be discontinued abruptly without dose tapering 2
  • However, for patients taking 15 mg or 20 mg daily, consider reducing to 10 mg daily for 1 week before full discontinuation to minimize potential withdrawal symptoms 2

Important Caveat: CYP2D6 Poor Metabolizers

  • The only population requiring dose adjustment is CYP2D6 poor metabolizers, who should have a maximum dose of 10 mg daily 2, 3
  • This recommendation is unrelated to renal function and applies regardless of kidney status 3

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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