Vilazodone Dosing and Administration for Major Depressive Disorder
Start vilazodone at 10 mg once daily with food for 7 days, then increase to 20 mg once daily with food, and may further increase to the target dose of 40 mg once daily after a minimum of 7 additional days. 1
Initial Dosing Protocol
The recommended target dosage is 20-40 mg once daily, always taken with food to optimize bioavailability. 1
Titration Schedule
- Week 1: Start at 10 mg once daily with food 1
- Week 2 onward: Increase to 20 mg once daily with food 1
- Week 3 onward (if needed): May increase to 40 mg once daily with food after minimum 7 days at 20 mg dose 1
Taking vilazodone with food is mandatory—this is not optional, as food significantly affects absorption and efficacy. 1
Critical Pre-Treatment Screening
Before initiating vilazodone, screen all patients for personal or family history of bipolar disorder, mania, or hypomania to avoid precipitating manic episodes. 1
Drug Interaction Dosing Adjustments
With Strong CYP3A4 Inhibitors
Do not exceed 20 mg once daily when co-administered with strong CYP3A4 inhibitors (itraconazole, clarithromycin, voriconazole). 1
- Resume original dose when CYP3A4 inhibitor is discontinued 1
With Strong CYP3A4 Inducers
Consider increasing vilazodone dosage by 2-fold, up to maximum 80 mg once daily, over 1-2 weeks in patients taking strong CYP3A4 inducers (carbamazepine, phenytoin, rifampin) for greater than 14 days. 1
- Gradually reduce back to original level over 1-2 weeks when CYP3A4 inducer is discontinued 1
MAOI Interactions
At least 14 days must elapse between discontinuation of an MAOI antidepressant and initiation of vilazodone, and vice versa. 1
Discontinuation Protocol
Never abruptly stop vilazodone—always taper gradually to minimize withdrawal symptoms. 1
Tapering Schedule from 40 mg
Tapering Schedule from 20 mg
- Reduce to 10 mg once daily for 7 days 1
Missed Dose Management
If a dose is missed, take it as soon as remembered unless it is almost time for the next dose—in that case, skip the missed dose entirely. 1
- Never take two doses at the same time 1
Clinical Context and Efficacy
Vilazodone is recognized by the American College of Physicians as having similar benefits to other second-generation antidepressants as first-step treatment for major depressive disorder in adults. 2
Significant improvements in depression symptoms (MADRS and HAM-D-17 scores) were demonstrated as early as week 1 in clinical trials, with the most common adverse events being diarrhea (28%), nausea (23.4%), and insomnia (6%), most of which were mild to moderate. 3, 4, 5
Critical Safety Monitoring
Closely monitor all patients for clinical worsening and emergence of suicidal thoughts and behaviors, particularly in young adults, as antidepressants carry a black box warning for increased suicide risk in this population. 1
Vilazodone is not approved for use in pediatric patients. 1