How to taper off vilazodone (Vilazodone) and initiate bupropion (Wellbutrin)?

From the Guidelines

Tapering off vilazodone and starting Wellbutrin should be done under medical supervision, with a gradual reduction of vilazodone over 2-4 weeks while introducing Wellbutrin at a low dose and gradually increasing it. When switching from one antidepressant to another, it's crucial to consider the potential for discontinuation symptoms and the time it takes for the new medication to become effective. According to the American College of Physicians guideline 1, when choosing pharmacologic therapy to treat patients with acute major depression, second-generation antidepressants should be selected based on adverse effect profiles, cost, and patient preferences.

Key considerations for tapering vilazodone include:

• Gradually reducing the dose over 2-4 weeks to minimize discontinuation symptoms such as dizziness, headache, nausea, and mood changes
• Starting Wellbutrin at a low dose, typically 150mg once daily, and increasing it as tolerated to the target dose
• Monitoring patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis, beginning within 1 to 2 weeks of initiation of therapy, as recommended by the American College of Physicians 1

The rationale behind this approach is to allow the brain to adapt to the changes in neurochemicals, as vilazodone affects serotonin levels, while Wellbutrin primarily affects dopamine and norepinephrine. It's essential to stay hydrated, maintain regular sleep patterns, and report any concerning side effects to the doctor during this transition. By following this gradual tapering and introduction method, patients can minimize potential side effects and increase the likelihood of a successful transition from vilazodone to Wellbutrin.

From the FDA Drug Label

2.5 Discontinuing Treatment with Vilazodone Hydrochloride Adverse reactions may occur upon discontinuation of vilazodone hydrochloride [see Warnings and Precautions (5. 5)]. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible. Vilazodone hydrochloride should be down tapered from the 40 mg once daily dose to 20 mg once daily for 4 days, followed by 10 mg once daily for 3 days. Patients taking vilazodone hydrochloride 20 mg once daily should be tapered to 10 mg once daily for 7 days.

To taper off vilazodone and start Wellbutrin, gradually reduce the vilazodone dosage as follows:

• If taking 40 mg once daily, taper to 20 mg once daily for 4 days, then to 10 mg once daily for 3 days.
• If taking 20 mg once daily, taper to 10 mg once daily for 7 days. After tapering off vilazodone, Wellbutrin can be initiated. However, the exact timing of initiation is not specified in the vilazodone label 2. Key considerations:
• Tapering vilazodone gradually is recommended to minimize adverse reactions.
• The vilazodone label does not provide specific guidance on initiating Wellbutrin after tapering off vilazodone.

From the Research

Tapering Off Vilazodone

• To taper off vilazodone, a gradual reduction in dose over time is recommended, as sudden discontinuation can lead to withdrawal symptoms 3.
• The most promising strategy for psychiatric drug discontinuation, including vilazodone, appears to be hyperbolic tapering by exponential dose reduction 3.
• However, there is a lack of standardization among guidelines, making it difficult for prescribers to determine the best approach for tapering off vilazodone 3, 4.

Starting Wellbutrin (Bupropion)

• Bupropion, also known as Wellbutrin, can be used to manage withdrawal symptoms, as seen in a case study where a patient with stimulant use disorder and unspecified bipolar disorder experienced significant improvement in psychotic and mood symptoms after starting bupropion 5.
• Bupropion has been shown to be effective in managing opioid withdrawal, with fewer adverse effects compared to other medications such as clonidine or lofexidine 6.
• When starting bupropion, it is essential to consider the patient's medical history, current medications, and potential interactions, as bupropion can interact with other drugs, including selective serotonin reuptake inhibitors (SSRIs) like vilazodone 7.

Combination of Tapering Off Vilazodone and Starting Wellbutrin

• There is limited research on the specific combination of tapering off vilazodone and starting Wellbutrin, and more studies are needed to provide guidance on this topic 4.
• However, based on the available evidence, a gradual tapering off vilazodone using a hyperbolic tapering strategy, followed by the introduction of Wellbutrin, may be a viable approach, but this should be done under the guidance of a healthcare professional 3, 5.