Vilazodone

Vilazodone is a prescription medication used for treating the symptoms of major depressive disorder.

• Vilazodone is available under the following different brand names: Viibryd

Adult dosage

Tablet

• 10mg
• 20mg
• 40mg

Major Depressive Disorder

Adult dosage

• 10 mg orally every day for 7 days with food; THEN increase to 20 mg every day with food
• May increase further up to 40 mg/day after a minimum of 7 days between dosage increases
• Target maintenance dose: 20-40 mg/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Vilazodone include:

• nausea,
• vomiting,
• diarrhea, and
• sleep problems (insomnia).

Serious side effects of Vilazodone include:

• convulsions (seizures),
• blurred vision,
• tunnel vision,
• eye pain or swelling,
• seeing halos around lights,
• easy bruising,
• unusual bleeding,
• racing thoughts,
• unusual risk-taking behavior,
• decreased inhibitions,
• feelings of extreme happiness or sadness,
• headache,
• confusion,
• slurred speech,
• severe weakness,
• loss of coordination, and
• feeling unsteady.

Rare side effects of Vilazodone include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Vilazodone has severe interactions with the following drugs:
  • isocarboxazid
  • phenelzine
  • rasagiline
  • selegiline
  • selegiline transdermal
  • tranylcypromine
• Vilazodone has serious interactions with at least 97 other drugs.
• Vilazodone has moderate interactions with at least 80 other drugs.
• Vilazodone has minor interactions with no other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity
• Coadministration with serotonergic drugs
• Do not use MAOIs concomitantly or within 14 days before initiating vilazodone or within 14 days after discontinuing vilazodone
• Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
• Starting vilazodone in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
• If linezolid or IV methylene blue must be administered, discontinue vilazodone immediately and monitor for CNS toxicity; may resume vilazodone 2 weeks after last linezolid or methylene blue dose

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Vilazodone?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Vilazodone?”

Cautions

• May precipitate mixed/manic episode if initiated for bipolar disorder
• May cause serotonin syndrome or neuroleptic malignant syndrome-like reactions, including agitation, hallucinations, coma, autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination), and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)
• Use with caution in patients with a history of seizures; has not been systematically evaluated in patients with seizure disorders (caution advised)
• Serotonin reuptake inhibitors may increase the risk of bleeding (caution with drugs that inhibit platelets or coagulation)
• Decrease dose gradually when discontinuing, to avoid dysphoric mood, irritability, insomnia, agitation, and confusion
• CYP3A4 (major substrate); CYP2C19 (minor substrate, minor inhibitor, minor inducer); CYP2D6 (minor substrate, minor inhibitor); CYP2C8 (moderate inhibitor); increased plasma concentration (by 50%) observed when coadministered with strong CYP3A4 inhibitors (eg, ketoconazole)
• Highly bound to plasma proteins (administration to patient taking another drug that is highly protein bound may increase free concentrations of the other drug)
• Hyponatremia has been reported with other SSRIs, and SNRIs; common adverse effects include diarrhea, nausea, xerostomia, dizziness, and insomnia; can occur in association with the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Bone fractures reported with antidepressant treatment; consider the possibility of a fragility fracture if an antidepressant treated patient presents with unexplained bone pain, swelling, point tenderness, or bruising;
• May cause sexual dysfunction
• MAOIs (see Contraindications)
• Coadministration with 5HT receptor agonist (ie, triptan), other serotonergic drugs (eg, SSRIs, SNRIs, buspirone, tramadol), or antidopaminergic drugs may increase the risk for serotonin syndrome
• Concomitant use with serotonin precursors (eg, tryptophan) is not recommended
• Serotonin reuptake inhibitors may increase the risk of bleeding (caution when coadministered with aspirin, NSAIDs, warfarin, and other anticoagulants)
• Risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy
• There is conflicting evidence regarding the use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn (PPHN; see Pregnancy)
• Prescribe the smallest quantity consistent with good patient care
• Abrupt discontinuation or interruption of therapy associated with discontinuation syndrome; antidepressants with shorter half-lives, prolonged treatment, or abrupt discontinuation, associated with increased risk of developing discontinuation syndrome; for antidepressants of short or intermediate half-lives, symptoms may emerge within 2-5 days after treatment discontinuation; may last 7-14 days
• Sexual dysfunction
  • Use of may cause symptoms of sexual dysfunction in both male and female patients; inform patients that they should discuss any changes in sexual function and potential management strategies with their healthcare provider
  • Use of SSRIs may cause symptoms of sexual dysfunction; in male patients, SSRI use may result in ejaculatory delay or failure, decreased libido, and erectile dysfunction
  • In female patients, SSRI/SNRI use may result in decreased libido and delayed or absent orgasm
  • Important for prescribers to inquire about sexual function before initiation of therapy and to inquire specifically about changes in sexual function during treatment because the sexual function may not be spontaneously reported
  • When evaluating changes in sexual function, obtaining a detailed history (including the timing of symptom onset) is important because sexual symptoms may have other causes, including underlying psychiatric disorder
  • Discuss potential management strategies to support patients in making informed treatment decisions.

Pregnancy and Lactation

• There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy
• Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/
• There are no adequate and well-controlled studies in pregnant women; a prospective, longitudinal study followed 201 pregnant women with a history of major depressive disorder who were euthymic and taking antidepressants at beginning of pregnancy; women who discontinued antidepressants during pregnancy were more likely to experience a relapse of major depression than women who continued antidepressants; consider the risks of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum
• Exposure in late pregnancy may lead to increased risk for neonatal complications requiring prolonged hospitalization, respiratory support, tube feeding, and/or persistent pulmonary hypertension of the newborn (PPHN); monitor neonates who were exposed to therapy in the third trimester of pregnancy for PPHN and drug discontinuation syndrome
• Persistent pulmonary hypertension of the newborn
• Potential risk of PPHN when used during pregnancy
• Initial public health advisory in 2006 was based on a single published study; since then, there have been conflicting findings from new studies, making it unclear whether the use of SSRIs during pregnancy can cause PPHN
• FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN
• FDA recommendation: FDA advises healthcare professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program
• Lactation
  • There are no data on presence in human milk, effects on the breastfed infant, or milk production; however, the drug is excreted in rat milk; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed child from the drug or underlying maternal condition.