TaperCommunityvilazodone
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Vilazodone is a selective serotonin reuptake inhibitor (SSRI) and partial agonist at the 5-HT1A receptor. It is used for the treatment of major depressive disorder.
10mg, 20mg, 40mg
Tablets: 10mg, 20mg, 40mg
Category C (risk cannot be ruled out)
Combined SSRI activity with 5-HT1A receptor partial agonism, providing dual serotonergic modulation. Blocks SERT while partially activating 5-HT1A autoreceptors.
Unique dual mechanism (SSRI + 5-HT1A partial agonist). Must be taken with food for adequate absorption. Taper slowly — withdrawal can include GI disturbance and dizziness.
Reduce gradually over months. Consider 10mg steps initially, then smaller reductions at lower doses. No liquid formulation available — tablet splitting may be necessary.
Toxicity
Serotonin syndrome risk when combined with serotonergic agents. GI side effects are the most common dose-limiting toxicity.
Pharmacokinetics
Oral bioavailability 72% with food (significantly reduced without food). Tmax ~4–5 hours. Must be taken with food.
Not well characterized; extensively distributed.
Hepatic via CYP3A4 (major), CYP2C19, and CYP2D6. Active metabolites are not clinically significant.
Primarily fecal (2% unchanged in urine).
96–99%
Apparent clearance ~40 L/hr
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