Mechanism of Action: vortioxetine is classified as a serotonin modulator and simulator (SMS) as it has a multimodal mechanism of action towards the serotonin neurotransmitter system whereby it simultaneously modulates one or more serotonin receptors and inhibits the reuptake of serotonin. More specifically, vortioxetine acts via the following biological mechanisms: as a serotonin reuptake inhibitor (SRI) through inhibition of the serotonin transporter, while also acting as a partial agonist of the 5-HT1B receptor, an agonist of 5-HT1A, and antagonist of the 5-HT3, 5-HT1D, and 5-HT7 receptors. –DrugBank
Indications: Major Depressive Disorder
Some (not all ) Interactions: any other antidepressant, buspirone, fentanyl, tramadol, lithium, St. John’s wort, tryptophan (sometimes called L-tryptophan), a blood thinner (warfarin, Coumadin, Jantoven), a diuretic or “water pill”, migraine headache medicine (triptans), NSAIDs (nonsteroidal anti-inflammatory drugs) – aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or, seizure medicine – carbamazepine, phenytoin. –Drugs.com
Dosing Forms: Trintellix is supplied as an immediate-release tablet in 5mg, 10mg, and 20mg strengths:
- Initial dose: 10 mg orally once a day
- Maintenance dose: 5 to 20 mg orally once a day
- Maximum dose: 20 mg/day
Pros
- Only needs to be taken once a day
- Can be used in adults of all ages
- Can be less likely to cause sexual side effects and weight gain compared to other antidepressants
- Can be especially helpful for people who have “brain fog” caused by depression
- May be helpful in some cases when other antidepressants haven’t worked
- Can start to work more quickly than other antidepressants
Cons
- It can take up to a month before you feel the full effects. It may have some withdrawal symptoms with discontinuing
- Not available as a generic, so it may be more expensive than other antidepressants
- Can interact with some other medications
- Not approved for use in children
Extra Notes:
- TAKE with food. This medication is known to cause major nausea, also consider prescribing Zofran. Nausea should be self-limiting.
- I wouldn’t prescribe this with kids/pregnancy but it’s not approved for those age groups. I’ll be too concerned about the nausea and reports of extreme mood symptoms, including SI.
- Also note, how Trintellix is one of the few antidepressants that can cause very low levels of sodium (some others are Fetzima (Levomilnacipran) and Lithium). Low sodium levels in your blood that may be serious and may cause death can happen during treatment with TRINTELLIX. Elderly people and people who take certain medicines may be at a greater risk for developing low sodium levels in your blood. Signs and symptoms may include headache; difficulty concentrating; memory changes; confusion; weakness and unsteadiness on your feet which can lead to falls. In more severe or more sudden cases, signs and symptoms include: seeing or hearing things that are not real; fainting; seizures; coma; stopping breathing. –Trintellix.com
- With the exception of the hyponatremia risks, I still think it’s good for the older population. I have a 65y/o who’s doing exceptionally well on this, with no side effects, and wonder if it can help those with dementia.
- There are also glaucoma risks: In some people with an underlying eye condition like glaucoma, Trintellix (vortioxetine) can lead to eye pain, swelling or redness, and changes in vision. -GoodRx
In May 2016 Takeda Pharmaceuticals U.S.A., Inc. and Lundbeck announced that Brintellix will be marketed in the United States under the new name Trintellix effective June 2016. The change comes after receiving reports of name confusion in the marketplace between Brintellix and the anti-blood clotting therapy Brilinta (ticagrelor). The formulation, indication, dosage forms, and strengths of Trintellix remain the same as Brintellix.
Additional Information
Official Medication Website: Trintellix (Vortioxetine)
