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
- Starting 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
Special Population Adjustments
CYP2D6 Poor Metabolizers
- Maximum dose: 10 mg daily in known CYP2D6 poor metabolizers 1
- This is the only population requiring mandatory dose adjustment based on pharmacogenetic considerations 2
Other Populations
- No dose adjustments required for sex, age, race, body size, renal impairment, or hepatic impairment 2
Dose Titration Strategy
For early optimization: In patients with severe MDD and comorbid generalized anxiety disorder, forced up-titration from 10 mg to 20 mg after 1 week has been shown to be well-tolerated and effective 3
Discontinuation Protocol
- Abrupt discontinuation is possible 1
- However, for doses of 15 mg or 20 mg daily: Reduce to 10 mg daily for one week prior to full discontinuation when possible 1
Drug Interaction Dose Modifications
Strong CYP2D6 Inhibitors (e.g., bupropion)
- Reduce Trintellix dose by half when coadministered 1
Strong CYP Inducers (e.g., rifampin)
- Consider dose increase when coadministered for more than 14 days 1
- Maximum dose should not exceed 3 times the original dose 1
Clinical Pharmacology Supporting Dosing
- Linear pharmacokinetics across the 5-20 mg dose range 2
- Terminal half-life: Approximately 66 hours 2
- Time to steady state: Generally achieved within 2 weeks 2
- Bioavailability: 75% with no food effect 2
Maintenance Therapy
All three doses (5 mg, 10 mg, and 20 mg) are effective for relapse prevention in patients who achieve remission, with cumulative relapse rates of 19.3%, 17.9%, and 17.4% respectively versus 32.5% for placebo over 28 weeks 4