Vilazodone (viibryd) - Dose, side effects, brands

Vilazodone has limited impact on dopamine and norepinephrine and is a selective serotonin reuptake inhibitor.
 

It is used to treat Major depressive disorder:

Vilazodone Dose in Adults

Dose in the treatment of Major depressive disorder (MDD):

    • 10 mg orally 1 tablet daily as a single tablet for 7 days, then increase to 20 mg/ day;
    • max 40mg/day, increase dose only weekly basis.

  • Discontinuation of therapy:

    • To lessen withdrawal symptoms and spot reemerging problems, the dose of antidepressant medication is progressively decreased (for example, over a period of 2 to 4 weeks) when treatment is stopped if it has been used for longer than 3 weeks.

    • Manufacturer labeling recommends:

      • Individuals receiving 40 mg/day should taper their dosage to 20 mg/day for 4 days, followed by 10 mg/day for 3 days.
        Individuals who are currently receiving 20 mg/day taper to 10 mg/day for 7 days.
    • The usage of a medication with a half-life of less than 24 hours (such as paroxetine or venlafaxine), a history of antidepressant withdrawal symptoms, or individuals using high dosages of antidepressants are only a few reasons to gradually increase the dose (for example, over a period of 4 weeks).
    • Take the patient on the previously specified dose and/or reduce dose more gradually if unbearable withdrawal symptoms do develop.
    • Tapering over more than three months may be beneficial for some individuals receiving long-term treatment (more than six months), such as those with a history of discontinuation syndrome.

  • MAO inhibitor recommendations:

    • Treating mental diseases with an MAO inhibitor instead of or in addition to:
      • When switching from an MAO inhibitor used to treat psychiatric problems to vilazodone, there should be a 14-day break between the two.

  • Use with other MAO inhibitors (IV methylene blue or linezolid):

    • Consider additional mental treatments for people receiving linezolid or intravenous methylene blue.
    • In individuals using the aforementioned drugs, it is not advised to utilise MAOs or vilazodone.
    • Vilazodone can be suddenly stopped and linezolid or IV methylene blue administered in situations where patients who are currently receiving vilazodone require urgent treatment and the possible advantages outweigh the potential dangers.
    • For two weeks or until 24 hours after the final dose of linezolid or IV methylene blue, whichever comes first, serotonin syndrome monitoring is necessary.
    • 24 hours after the last dosage of linezolid or IV methylene blue, vilazodone can be resumed.

  • Dosing adjustment for concomitant medications:

    • Drugs which are strong inhibitors of CYP3A4 (eg, clarithromycin, itraconazole, voriconazole):
      • The maximum daily dose of vilazodone when using such medications is 20mg.
      • After stopping CYP3A4 inhibitors, return to the previous dosage of vilazodone.
    • Drugs which are strong inducers of CYP3A4 (eg, carbamazepine, phenytoin, rifampin):
      • Based on the clinical response to vilazodone, consider raising the dose by twofold (maximum dose - 80 mg/day) when taken at the same time for longer than 14 days.
    • Maximum daily dose:
      • 80 mg. After stopping the CYP3A4 inducer over a period of 7 to 14 days, start taking vilazodone again at the original dosage.

Vilazodone Dose in Children

Not recommended for use in children 

Pregnancy Risk Factor: C

  • Use of Vilazodone (viibryd), during lactation

  • Studies on animal reproduction have shown that there are adverse events.
  • Mothers who use other SSRIs may have an increased chance of experiencing adverse events.
  • However, it is not known if vilazodone can be teratogenic.
  • Mothers who used the drug may have non-teratogenic effects on their newborns.SSRISNRI late during the third trimester of pregnancy, such as:
    • Respiratory distress
    • Cyanosis
    • Temperature instability
    • Apnea
    • Seizure
    • Vomiting
    • Feeding difficulty
    • Hypoglycemia
    • Hypotonia and hypertonia.
    • Hyperreflexia
    • Chitteriness
    • Irritation
    • Tremors and
    • Constant crying.
  • Possible to cause persistent pulmonary hypertension in the newborn (PPHN), if SSRIs are used.
  • ACOG recommends that therapy with SSRIs and SNRIs during pregnancy is individualized
  • The clinical expertise of the mental healthcare clinician, the obstetrician and primary healthcare provider should all be used to treat depression in pregnancy.
  • Pregnant women should not be exposed to untreated depression.
  • Women who have stopped taking antidepressants during pregnancy can resume their medication after delivery. However, they may be at risk for postpartum depression.
  • Pregnant women should use a safer alternative medication.

Vilazodone Use During Breastfeeding:

  • It is unknown if Vilazodone is excreted in breast milk.
  • If the benefits are greater than the risks, continue using it.
  • Pregnancy with vilazodone may result in delayed milk production. Studies on long-term effects of vilazodone on behavior and development are still ongoing.

Vilazodone Dose in Renal Disease:

No dosage adjustment is necessary.

Vilazodone Dose in Liver Disease:

No dosage adjustment is necessary. 

Common Side Effects of Vilazodone (viibryd) Include:

  • Central nervous system:

    • Headache

  • Gastrointestinal:

    • Diarrhea
    • Nausea

Less Common Side Effects of Vilazodone (viibryd) Include:

  • Cardiovascular:

    • Palpitations

  • Central Nervous System:

    • Dizziness
    • Insomnia
    • Drowsiness
    • Fatigue
    • Abnormal Dreams
    • Restlessness
    • Paresthesia
    • Delayed Ejaculation
    • Migraine
    • Sedation
    • Panic Attack
    • Ventricular Premature Contractions

  • Dermatologic:

    • Hyperhidrosis
    • Night Sweats

  • Endocrine & Metabolic:

    • Decreased Libido
    • Weight Gain

  • Gastrointestinal:

    • Xerostomia
    • Abdominal Pain
    • Vomiting
    • Dyspepsia
    • Flatulence
    • Increased Appetite
    • Abdominal Distension
    • Gastroenteritis

  • Genitourinary:

    • Erectile Dysfunction
    • Orgasm Disturbance

  • Neuromuscular & Skeletal:

    • Arthralgia
    • Tremor

  • Ophthalmic:

    • Blurred Vision
    • Xerophthalmia

Contraindication to Vilazodone Include:

  • Use of an MAO inhibitor in conjunction with vilazodone. (including MAO inhibitors like intravenous Methylene Blue or linezolid).
  • Allergy to vilazodone and any component of the formulation

Warnings and Precautions

  • Bleeding Risk:
    • The risk of bleeding is higher when it interferes with platelet aggregation.
    • This is especially true if the medication is taken in combination with NSAIDs, warfarin or other anticoagulants such as aspirin.
    • Reports of bleeding, including GI bleeding, have been reported in connection to the use SSRI and SNRI.
    • These bleeding range from minor bruising and epistaxis up to life-threatening hemorhage.
  • Fractures
    • Antidepressant therapy has been linked to bone fractures.
    • Fragility fractures should be considered for patients with undiagnosed bone pain, tenderness, bruising or swelling.
  • Ocular effects
    • Sensitive individuals may be at risk for a mild case of narrow-angle, or even fatal, glaucoma.
    • Patients who have not had an iridectomy to reduce narrow-angle glaucoma risks factors are required to be evaluated.
  • Serotonin syndrome
    • Serotonin syndrome can be a potentially life-threatening adverse reaction to serotonergic drugs (eg SSRIs, SNRIs), especially when combined with other serotonergic medications (eg triptans TCAs or fentanyl), such as buspirone, fentanyl and tramadol, fentanyl.
    • Patients with serotonin syndrome are closely watched for symptoms including mental changes, agitation, hallucinations or delirium, coma, autonomic instability (such as tachycardias, labile pressure, diaphoresis), neuromuscular disorders (such as tremors, rigidity, and myoclonus), GI symptoms (such as nausea, vomiting, and diarrhoea), and/or seizures.
    • If any symptoms or signs develop, the treatment must be stopped very away.
  • Sexual dysfunction
    • This can lead to or worsen existing dysfunction.
  • SIADH and Hyponatremia
    • SIADH was developed through the use of SSRIs/SNRIs.
    • Hyponatremia has been reported, with severe cases of serum sodium 110 mg/L. This is most common in the elderly.
    • This condition can be reversed and resolved by stopping the drug.
    • Concurrent use of diuretics increases the risk of volume loss.
  • Hypomania and mania:
    • Bipolar disorder patients may experience worsening psychosis, or a shift towards mania or hypomania.
    • Before starting treatment, patients must be screened for a family or personal history of bipolar disorder or mania.
  • Seizure disorder
    • Patients with a history of seizure disorders or other conditions that can lead to seizures, such as brain damage or addiction, should be cautious.

Vilazodone: Drug Interaction

Risk Factor C (Monitor therapy)

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)

May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.

Anticoagulants

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.

Antiemetics (5HT3 Antagonists)

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Antipsychotic Agents

Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Apixaban

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely.

Aspirin

Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Aspirin.

Beta-Blockers

Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Beta-Blockers. Exceptions: Acebutolol; Atenolol; Betaxolol (Ophthalmic); Betaxolol (Systemic); Bisoprolol; Carteolol (Ophthalmic); Esmolol; Labetalol; Levobunolol; Metipranolol; Nadolol; Sotalol.

Blood Glucose Lowering Agents

Selective Serotonin Reuptake Inhibitors may enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Bosentan

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Brexanolone

Selective Serotonin Reuptake Inhibitors may enhance the CNS depressant effect of Brexanolone.

BuPROPion

May enhance the adverse/toxic effect of Vilazodone. Specifically, the risk for seizures and serotonin syndrome may be increased.

Cephalothin

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.

CNS Depressants

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.

Collagenase (Systemic)

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.

CYP3A4 Inducers (Moderate)

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

CYP3A4 Inhibitors (Moderate)

May increase the serum concentration of Vilazodone.

Cyproheptadine

May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.

Dabigatran Etexilate

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Dabigatran Etexilate. Agents with Antiplatelet Properties may increase the serum concentration of Dabigatran Etexilate. This mechanism applies specifically to clopidogrel. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.

Dasatinib

May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Deferasirox

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Deoxycholic Acid

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.

Desmopressin

Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Desmopressin.

Digoxin

Vilazodone may increase the serum concentration of Digoxin.

Edoxaban

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased.

Erdafitinib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Fat Emulsion (Fish Oil Based)

Agents with poisonous or harmful effects may intensify their negative or hazardous effects.

Glucosamine

Agents with antiplatelet properties may have an enhanced antiplatelet impact.

Ibritumomab Tiuxetan

Antiplatelet agents may intensify the toxic/unfavorable effects of ibritumomab tiuxetan. Both substances may raise the risk of bleeding and compromise platelet function.

Ibrutinib

Agents with poisonous or harmful effects may intensify their negative or hazardous effects.

Inotersen

Agents with antiplatelet properties may have an enhanced antiplatelet impact.

Ioflupane I 123

Ioflupane I 123's ability to diagnose conditions may be diminished by selective serotonin reuptake inhibitors.

Ivosidenib

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Limaprost

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Metaxalone

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Methylphenidate

May enhance the adverse/toxic effect of Serotonin Modulators. Specifically, the risk of serotonin syndrome or serotonin toxicity may be increased.

MetyroSINE

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.

Multivitamins/Fluoride (with ADE)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Minerals (with ADEK, Folate, Iron)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Minerals (with AE, No Iron)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)

Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.

Nonsteroidal Anti-Inflammatory Agents (Topical)

May enhance the antiplatelet effect of Selective Serotonin Reuptake Inhibitors.

Obinutuzumab

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.

Omega-3 Fatty Acids

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Opioid Agonists

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Pentosan Polysulfate Sodium

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.

Pentoxifylline

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Prostacyclin Analogues

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

RisperiDONE

Selective Serotonin Reuptake Inhibitors may decrease the metabolism of RisperiDONE.

Rivaroxaban

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Rivaroxaban. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.

Salicylates

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.

Sarilumab

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Serotonin Modulators

May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid.

Siltuximab

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Tedizolid

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Thiazide and Thiazide-Like Diuretics

Thiazide and Thiazide-Like Diuretics may have an enhanced hyponatremic impact when used with Selective Serotonin Reuptake Inhibitors.

Thrombolytic Agents

The anticoagulant impact of thrombolytic agents may be strengthened by agents with antiplatelet properties.

Thyroid Products

The therapeutic impact of thyroid products may be diminished by selective serotonin reuptake inhibitors. The dosage needs for thyroid medications may be raised.

Tipranavir

Agents with antiplatelet properties may have an enhanced antiplatelet impact.

Tocilizumab

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

TraMADol

Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Vitamin E (Systemic)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Vitamin K Antagonists (eg, warfarin)

Selective Serotonin Reuptake Inhibitors may enhance the anticoagulant effect of Vitamin K Antagonists.

Risk Factor D (Consider therapy modification)

Alcohol (Ethyl)

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors.

Bemiparin

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.

BusPIRone

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Management: The combination of a selective serotonin reuptake inhibitor and buspirone should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.

CYP3A4 Inducers (Strong)

Vilazodone serum concentration can drop. Management: If a patient has been taking a powerful CYP3A4 inducer for more than 14 days, consider raising the dose of vilazodone by up to double (do not exceed 80 mg/day), depending on the patient's response. After stopping the inducer, lower the vilazodone dosage over a period of one to two weeks.

CYP3A4 Inhibitors (Strong)

Vilazodone serum concentration can rise. Management: In patients using potent CYP3A4 inhibitors, the daily maximum adult dose of vilazodone should be 20 mg. After stopping the potent CYP3A4 inhibitor, the original vilazodone dosage can be resumed.

Dabrafenib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).

Dextromethorphan

Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Dextromethorphan. Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dextromethorphan. Management: Avoid the concurrent use of dextromethorphan and SSRIs, particularly fluoxetine and paroxetine, when possible. The risk for this interaction may persist for several weeks following discontinuation of fluoxetine or paroxetine.

Enoxaparin

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.

Enzalutamide

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP3A4 substrates that have a limited therapeutic index. Enzalutamide use, along with the use of any other CYP3A4 substrate, should be done with caution.

Gilteritinib

May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Avoid use of this combination if possible. If the combination cannot be avoided, monitor closely for evidence of reduced response to the selective serotonin reuptake inhibitor.

Heparin

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required.

Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.

Linezolid

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could result in serotonin syndrome. Management: Consider alternatives to this combination whenever possible. If clinically acceptable, wait at least 2 weeks (5 weeks for fluoxetine) after SSRI discontinuation to initiate linezolid.

Linezolid

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Due to a risk of serotonin syndrome/serotonin toxicity, discontinue serotonin modulators 2 weeks prior to the administration of linezolid. If urgent initiation of linezolid is needed, discontinue serotonin modulators immediately and monitor closely.

Lithium

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could increase the risk of serotonin toxicity/serotonin syndrome. Management: This combination should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.

Lorlatinib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.

Metoclopramide

The negative or hazardous effects of selective serotonin reuptake inhibitors might be increased. Management: When possible, look for substitutions for this combination. Serotonin syndrome, neuroleptic malignant syndrome, and extrapyramidal symptoms should all be watched out for in individuals taking metoclopramide along with selective serotonin reuptake inhibitors.

Mitotane

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.

Nonsteroidal Anti-Inflammatory Agents (Nonselective)

Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2selective NSAIDs reduce risk. Exceptions: Diclofenac (Topical); Ibuprofen (Topical); Piroxicam (Topical).

Pitolisant

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant.

Serotonin Reuptake Inhibitor/Antagonists

Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Serotonin Reuptake Inhibitor/Antagonists. This may cause serotonin syndrome. Management: Consider alternatives, and use conservative initial dosing. Monitor patients receiving these combinations for signs/symptoms of serotonin toxicity.

St John's Wort

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Certain contraindications may apply to some combinations. the relevant manufacturer's label.

Risk Factor X (Avoid combination)

Bromopride

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.

Dapoxetine

May enhance the adverse/toxic effect of Serotonin Modulators.

Dothiepin

Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dothiepin.

Methylene Blue

Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Methylene Blue. This could result in serotonin syndrome.

Methylene Blue

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Monoamine Oxidase Inhibitors

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details. Exceptions: Linezolid; Methylene Blue; Tedizolid.

Pimozide

Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Pimozide. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs as appropriate.

Tryptophan

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome.

Urokinase

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.

 Monitor patients periodically for:

  • Treatment of symptoms
  • Depression and mental health
  • Suicidal thoughts (especially when the doses are increased/ decreased or at the beginning of therapy)
  • Anxiety
  • Social functioning
  • Mania
  • Panic attacks
  • Serotonin syndrome symptoms and signs
  • Akathisia

How to administer Vilazodone?

  • Should be taken with food.

Mechanism of action of Vilazodone (viibryd):

  • Vilazodone works by inhibiting serotonin uptake by CNS neurons. 
  • There is minimal to no effect on norepinephrine or dopamine reuptake.
  • It also is a 5-HT-1A receptor partial agonist and selectively binds with high affinity to 5-HT-1A receptors. 
  • Depression and anxiety may alter the activity of the 5-HT-1A receptor.

Protein binding:

  • 96% - 99% of the drug is bound to proteins.

Metabolism:

  • Liver

Bioavailability:

  • 72% when taken with food; 50% when taken without meals.

Half-life elimination:

  • Terminal: 25 hours

Time to peak, serum:

  • Takes 4 - 5 hours to reach peak levels in the serum.

Excretion:

  • Urine (1% as unchanged drug), feces (2% as unchanged drug)   

International Brands of Vilazodone:

  • Tristspire
  • Viibryd
  • Viibryd Starter Pak
  • Vilazodep
  • Vintix
  • Visdon

Vilazodone Brands in Pakistan:

Vilazodone is not available in Pakistan. 

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