Maximum Dose of Viibryd for Female Adults with Major Depressive Disorder
The maximum recommended dose of Viibryd (vilazodone) is 40 mg once daily, taken with food. 1
FDA-Approved Dosing Regimen
The FDA label provides explicit dosing instructions that must be followed 1:
- Initial dose: 10 mg once daily with food for 7 days 1
- Titration: Increase to 20 mg once daily with food after the first week 1
- Target dose: 20-40 mg once daily with food 1
- Maximum dose: 40 mg once daily—do not exceed this dose 1
The dose may be increased from 20 mg to 40 mg after a minimum of 7 days between dosage increases 1.
Critical Administration Requirements
Vilazodone must be taken with food to achieve optimal bioavailability and effectiveness 1, 2. This is not optional—taking vilazodone on an empty stomach significantly reduces absorption and therapeutic efficacy 2.
Dose Adjustments with Drug Interactions
When vilazodone is combined with certain medications, the maximum dose changes 1:
- With strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin, voriconazole): Maximum dose is 20 mg once daily 1
- With strong CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin) for >14 days: Consider increasing dose by 2-fold up to maximum 80 mg once daily over 1-2 weeks 1
Efficacy at Maximum Dose
Clinical trials demonstrated that vilazodone 40 mg once daily produces significant improvements in depression symptoms compared to placebo 3, 4, 5. In pivotal 8-week studies, vilazodone 40 mg/day significantly reduced Montgomery-Åsberg Depression Rating Scale (MADRS) total scores compared to placebo, with improvements observed as early as week 1 in some trials 3, 5.
Safety and Tolerability at 40 mg Daily
The 40 mg dose was generally well tolerated in both short-term (8-week) and long-term (52-week) studies 4, 5. The most common adverse events at this dose were 4:
- Diarrhea (28.0% vs 9.2% placebo)
- Nausea (23.4% vs 5.1% placebo)
- Insomnia (6.0% vs 2.1% placebo)
Most adverse events were mild to moderate, with discontinuation rates due to adverse events of 7.1% in 8-week studies 4.
Important Clinical Considerations
There is no evidence supporting doses above 40 mg once daily for standard treatment of major depressive disorder 1. The only exception is when strong CYP3A4 inducers are used concomitantly for more than 14 days, which may require up to 80 mg once daily 1.
Vilazodone had minimal impact on sexual function and body weight compared to other antidepressants, which may be particularly relevant for female patients concerned about these side effects 3, 5.
Common Pitfalls to Avoid
- Do not exceed 40 mg daily in standard treatment without documented use of strong CYP3A4 inducers 1
- Do not administer without food—this significantly reduces bioavailability 1, 2
- Do not increase doses more frequently than every 7 days—this increases gastrointestinal side effects 1, 6
- Do not combine with MAOIs or use within 14 days of stopping MAOIs 1