Vilazodone
Generic Name: Vilazodone
Brand Names: Viibryd
Vilazodone is an antidepressant combining SSRI activity with serotonin receptor agonism for treating major depressive disorder.
Drug Class
Selective Serotonin Reuptake Inhibitor (SSRI) and 5-HT₁A Receptor Partial Agonist
Pregnancy
Not recommended during pregnancy unless clearly necessary. Use in the third trimester may cause neonatal withdrawal symptoms, respiratory distress, and persistent pulmonary hypertension of the newborn (PPHN).
Available Forms
Tablet
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Major Depressive Disorder | 10 mg once daily for 7 days, then 20 mg once daily for 7 days | 20–40 mg once daily |
| With Strong CYP3A4 Inhibitors | Reduce dose; do not exceed 20 mg/day | 20 mg once daily maximum |
| With Strong CYP3A4 Inducers | Consider dose increase based on response (max 80 mg/day with short-term inducer use) | Adjust based on clinical response |
Side Effects
Common Side Effects:
- Diarrhea
- Nausea
- Vomiting
- Insomnia
- Dizziness
- Dry mouth
- Fatigue
Serious Side Effects:
- Serotonin syndrome
- Suicidal ideation (especially young adults)
- Bleeding events
- Hyponatremia
- Mania/hypomania activation
Drug Interactions
Major Interactions:
- MAO inhibitors (e.g., phenelzine, tranylcypromine, linezolid, methylene blue IV) — Concurrent use is contraindicated; can cause serotonin syndrome, a potentially fatal condition. Allow at least 14 days between stopping an MAOI and starting vilazodone, and vice versa
- Other serotonergic drugs (e.g., triptans, tramadol, St. John’s Wort, tryptophan, other SSRIs/SNRIs) — Increased risk of serotonin syndrome; symptoms include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle twitching, and hyperthermia
- NSAIDs, aspirin, and anticoagulants (e.g., warfarin) — SSRIs impair platelet aggregation; concurrent use increases the risk of gastrointestinal and other bleeding
- Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) — Increase vilazodone levels; do not exceed 20 mg/day when combined
- Drugs that lower seizure threshold — Use caution with concurrent medications that may lower the seizure threshold
Additional Information
Vilazodone is a selective serotonin reuptake inhibitor (SSRI) and partial serotonin 5-HT1A receptor agonist used to treat major depressive disorder. This dual mechanism may provide antidepressant and anxiolytic effects.
Mechanism of Action
Vilazodone has a unique dual mechanism:
- Serotonin reuptake inhibition: Blocks SERT, increasing synaptic serotonin
- 5-HT1A partial agonism: Partial agonist at presynaptic and postsynaptic 5-HT1A receptors
- May accelerate onset: 5-HT1A partial agonism may facilitate faster antidepressant response
- Anxiolytic effects: 5-HT1A agonism contributes to anti-anxiety properties
The combination may provide enhanced serotonergic neurotransmission with potentially improved tolerability.
Available Formulations
Vilazodone is available as tablets:
- 10 mg, 20 mg, 40 mg tablets (Viibryd)
Medical Uses
FDA-Approved Indication:
- Major depressive disorder in adults
Dosing Guidelines
Adults:
- Day 1-7: 10 mg once daily with food
- Day 8-14: 20 mg once daily with food
- Day 15+: 40 mg once daily with food
Maximum dose:
- 40 mg once daily
With Strong CYP3A4 Inhibitors:
- Do not exceed 20 mg daily
With Strong CYP3A4 Inducers:
- Consider increasing dose up to 2-fold (max 80 mg/day) based on response
Discontinuation:
- Gradual dose reduction recommended to minimize withdrawal symptoms
Important Safety Information
Black Box Warning:
- Increased risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders
Contraindications:
- Concomitant use with MAOIs or within 14 days of stopping MAOI
- Starting vilazodone in patients being treated with linezolid or IV methylene blue
Warnings and Precautions:
- Serotonin syndrome: Risk with other serotonergic drugs
- Increased bleeding risk: May impair platelet aggregation
- Activation of mania/hypomania: Use with caution in bipolar disorder
- Seizures: Use with caution in patients with seizure history
- Hyponatremia: SIADH has been reported
- Angle-closure glaucoma: May cause pupillary dilation
Drug Interactions
- MAOIs: Contraindicated; risk of serotonin syndrome
- Strong CYP3A4 inhibitors (ketoconazole, erythromycin): Limit vilazodone to 20 mg daily
- Strong CYP3A4 inducers (carbamazepine): Consider dose increase
- Serotonergic drugs (triptans, tramadol, lithium): Increased serotonin syndrome risk
- NSAIDs, aspirin, anticoagulants: Increased bleeding risk
- Drugs highly bound to plasma proteins: May displace or be displaced
Special Populations
- Hepatic Impairment: No adjustment needed
- Renal Impairment: No adjustment for mild to moderate; not studied in severe
- Elderly: No adjustment; consider slower titration
- Pregnancy: May cause persistent pulmonary hypertension and withdrawal in neonates
- Lactation: Present in breast milk; consider risk vs benefit
- Pediatric: Not approved; black box warning applies
Frequently Asked Questions
Questions to Ask Your Doctor
Consider discussing these topics at your next appointment:
- ✓Ask your doctor about signs and symptoms of serotonin syndrome and when to seek emergency care.
- ✓Discuss how to gradually taper vilazodone if you and your doctor decide to stop treatment.
- ✓Ask whether vilazodone may affect your ability to drive or operate machinery, especially during the initial titration period.
- ✓Discuss any history of bipolar disorder, as vilazodone may trigger manic episodes in susceptible individuals.
- ✓Ask about monitoring for suicidal thoughts, especially during the first few months of treatment or dose changes.
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
Related Medications
Other medications in the same category
Questions About This Medication?
Talk to your doctor or pharmacist about whether Vilazodone is right for you.
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