Tapering Viibryd (Vilazodone)
For patients on 40 mg daily, taper to 20 mg once daily for 4 days, then 10 mg once daily for 3 days before discontinuation; patients on 20 mg daily should taper to 10 mg once daily for 7 days before stopping. 1
FDA-Approved Tapering Protocol
The FDA label for vilazodone provides explicit tapering instructions that should be followed to minimize discontinuation symptoms 1:
- For 40 mg daily dose: Reduce to 20 mg once daily for 4 days, followed by 10 mg once daily for 3 days, then discontinue 1
- For 20 mg daily dose: Reduce to 10 mg once daily for 7 days, then discontinue 1
- Critical requirement: All doses must be taken with food to maintain proper bioavailability 1, 2
Rationale for Gradual Tapering
The FDA explicitly states that "a gradual reduction in dosage rather than abrupt cessation is recommended whenever possible" to prevent adverse reactions upon discontinuation 1. This approach is consistent with broader SSRI tapering principles, where abrupt discontinuation frequently causes withdrawal syndromes that can be severe and may compel patients to restart medication 3.
Monitoring During Taper
While the FDA protocol is relatively brief (7-11 days total), clinicians should:
- Assess for withdrawal symptoms at each dose reduction, including dizziness, nausea, headache, paresthesia, irritability, anxiety, and insomnia 1
- Watch for serotonin syndrome if the patient is on other serotonergic medications 1
- Monitor for depression recurrence, as vilazodone is effective for major depressive disorder and symptom return may occur 4
Important Clinical Considerations
If withdrawal symptoms become intolerable, return to the previous well-tolerated dose and implement a slower taper 3. Research on SSRI discontinuation suggests that tapers over months down to doses much lower than therapeutic minimums show greater success in reducing withdrawal symptoms compared to the brief tapers typically recommended 3.
For patients on long-term therapy (many months to years), consider extending the taper beyond the FDA's minimum recommendation, potentially reducing by 10% of the previous dose every 2-4 weeks, similar to principles used for other antidepressants 3.
Common pitfall: The FDA taper schedule represents the minimum recommended duration. Patients who have been on vilazodone for extended periods or who are particularly sensitive to medication changes may require slower tapers 3.
Special Warnings
- Never abruptly discontinue vilazodone, as this increases risk of withdrawal syndrome 1
- Maintain food intake with each dose during taper, as vilazodone requires food for optimal absorption 1, 2
- Screen for bipolar disorder before initiating any taper, as discontinuation may unmask underlying mood instability 1