Trintellix (Vortioxetine) Dosing
The recommended starting dose of Trintellix is 10 mg orally once daily, which should then be increased to 20 mg daily as tolerated, with 5 mg daily reserved for patients who cannot tolerate higher doses. 1
Standard Dosing Regimen
- Initial dose: 10 mg once daily, administered orally without regard to meals 1
- Target dose: 20 mg once daily, as tolerated 1
- Lower dose option: 5 mg once daily for patients who do not tolerate higher doses 1
- Dosing frequency: Once daily administration 1
- Food considerations: Can be taken with or without food 1
Dose Adjustments for Special Populations
CYP2D6 Poor Metabolizers
- Maximum dose is 10 mg daily in known CYP2D6 poor metabolizers 1
- This is the only population requiring mandatory dose adjustment based on FDA labeling 1
Drug Interactions Requiring Dose Modification
- With strong CYP2D6 inhibitors (e.g., bupropion): Reduce Trintellix dose by half 1
- With strong CYP inducers (e.g., rifampin): Consider increasing Trintellix dose when coadministered for more than 14 days, but do not exceed 3 times the original dose 1
Discontinuation Strategy
- Trintellix can be discontinued abruptly without a mandatory taper 1
- However, for doses of 15 mg or 20 mg daily: It is recommended to reduce to 10 mg daily for one week prior to full discontinuation if possible 1
Clinical Efficacy Across Dose Range
- All three doses (5 mg, 10 mg, and 20 mg) are effective for relapse prevention in patients who achieved remission on 10 mg daily, with cumulative relapse rates of 19.3%, 17.9%, and 17.4% respectively versus 32.5% for placebo over 28 weeks 2
- Pharmacokinetics are linear and dose-proportional across the 5-20 mg range, with steady-state achieved within 2 weeks 3
- The mean terminal half-life is approximately 66 hours, supporting once-daily dosing 3