Home Drug Guide Vortioxetine

Drug Guide

Generic Name

Vortioxetine

Brand Names Brintellix, Trintellix

Classification

Therapeutic: Antidepressant

Pharmacological: Serotonin modulator and stimulator

FDA Approved Indications

  • Major depressive disorder (MDD)

Mechanism of Action

Vortioxetine functions as a serotonin modulator and stimulator. It inhibits the reuptake of serotonin and modulates serotonergic activity through multiple receptor actions, including antagonism at 5-HT3 and 5-HT7 receptors, and agonism at 5-HT1A receptors, contributing to its antidepressant effects.

Dosage and Administration

Adult: Typically 10-20 mg once daily, with or without food. Dose adjustments may be considered based on clinical response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment necessary, but elderly patients should be monitored closely.

Renal Impairment: No dosage adjustment needed for mild to moderate impairment; caution advised in severe impairment.

Hepatic Impairment: Start with lower doses, as hepatic impairment may affect metabolism.

Pharmacokinetics

Absorption: Well absorbed orally, peak plasma levels in about 6-8 hours.

Distribution: Extensive protein binding (~98%).

Metabolism: Primarily hepatic via CYP2D6; minor involvement of CYP3A4/5 and CYP2C19.

Excretion: Excreted mainly via urine and feces.

Half Life: Approximately 66 hours, allowing once-daily dosing.

Contraindications

  • Known hypersensitivity to vortioxetine or excipients.

Precautions

  • Use with caution in patients with a history of seizures, bipolar disorder, or bleeding disorders. Monitor for bleeding, especially when combined with other medications that increase bleeding risk. Caution advised in patients taking other serotonergic drugs due to risk of serotonin syndrome.

Adverse Reactions - Common

  • Nausea (High)
  • Headache (Moderate)
  • Dizziness (Moderate)
  • Dry mouth (Moderate)

Adverse Reactions - Serious

  • Serotonin syndrome (Rare)
  • Bleeding events (e.g., gastrointestinal bleeding) (Rare)
  • Hyponatremia (Rare)
  • Suicidal thoughts or behavior in young adults and adolescents (black box warning) (Not established)

Drug-Drug Interactions

  • Other serotonergic agents (SSRIs, SNRIs, triptans, MAOIs) due to serotonin syndrome risk.
  • CYP2D6 inhibitors (e.g., fluoxetine, quinidine) which may increase vortioxetine levels.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess mental status and suicidal ideation prior to and during therapy.

Diagnoses:

  • Risk for suicidal ideation or behavior
  • Risk for bleeding
  • Risk for serotonin syndrome

Implementation: Initiate at recommended dose, monitor for adverse effects, particularly serotonin syndrome and bleeding.

Evaluation: Monitor for therapeutic response and adverse effects; reassess safety regularly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any unusual changes in mood, behavior, or thoughts of self-harm.
  • Be aware of signs of serotonin syndrome (agitation, hallucinations, coma) and bleeding.
  • Avoid concurrent use of other serotonergic drugs unless advised by healthcare provider.
  • Do not discontinue abruptly without consulting healthcare provider.

Special Considerations

Black Box Warnings:

  • Suicidality in children, adolescents, and young adults

Genetic Factors: No specific genetic testing required but CYP2D6 metabolic status can influence drug levels.

Lab Test Interference: No significant interference with routine laboratory tests.

Overdose Management

Signs/Symptoms: Symptoms may include nausea, vomiting, dizziness, tremor, and serotonin syndrome.

Treatment: Supportive care, stabilization of vital signs, and monitoring. No specific antidote; activated charcoal may be used if ingestion was recent.

Storage and Handling

Storage: Store at room temperature, 15-30°C (59-86°F).

Stability: Stable under recommended storage conditions until expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.