TaperCommunityvortioxetine
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Vortioxetine is a multimodal serotonergic antidepressant approved for major depressive disorder. Beyond SERT inhibition, it has direct activity at multiple serotonin receptors, which may contribute to pro-cognitive effects.
5mg, 10mg, 20mg
Tablets: 5mg, 10mg, 20mg
No assigned category; see FDA labeling (approved post-2015 PLLR rule)
Multimodal serotonergic agent: inhibits the serotonin transporter (SERT) and also acts as a 5-HT3, 5-HT7, and 5-HT1D receptor antagonist, 5-HT1B partial agonist, and 5-HT1A agonist.
Relatively long half-life. Tablets can be split. Limited withdrawal data compared to older SSRIs.
Newer drug with less tapering data. Apply general SSRI hyperbolic tapering principles. Tablets may be split.
Toxicity
Serotonin syndrome with serotonergic combinations. Generally well tolerated; nausea is the most common adverse effect.
Pharmacokinetics
Well absorbed orally. Absolute bioavailability ~75%. Tmax 7–11 hours. Food does not affect pharmacokinetics.
~2600 L (~33 L/kg)
Extensively metabolized hepatically via CYP2D6 (primary), CYP3A4/5, CYP2C9, CYP2C19, CYP2A6, and CYP2C8. Major metabolite is pharmacologically inactive.
Renal (~59%) and fecal (~26%). Negligible unchanged drug in urine.
~98%
~33 L/hr (oral clearance)
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