Home Drug Guide Vortioxetine Hydrobromide

Drug Guide

Generic Name

Vortioxetine Hydrobromide

Brand Names Trintellix

Classification

Therapeutic: Antidepressant

Pharmacological: Serotonin modulator and stimulator (SMS)

FDA Approved Indications

  • Major depressive disorder (MDD) in adults

Mechanism of Action

Vortioxetine is a serotonin modulator and stimulator. It acts as a serotonin reuptake inhibitor and also modulates various serotonin receptors, including antagonism at 5-HT3, 5-HT7, and partial agonism at 5-HT1B, which results in increased serotonergic activity in the brain.

Dosage and Administration

Adult: Initial dose is 10 mg once daily, adjustable to 5-20 mg based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Start at 10 mg once daily; adjust as needed, considering renal function and tolerability.

Renal Impairment: Use with caution; consider lower starting dose.

Hepatic Impairment: Use with caution; lower initial dose recommended.

Pharmacokinetics

Absorption: Well absorbed orally, peak plasma levels in about 7 hours.

Distribution: Binding to plasma proteins approximately 98%.

Metabolism: Primarily metabolized in the liver via CYP2D6, CYP3A4/5.

Excretion: Excreted mainly as metabolites via urine and feces.

Half Life: Approximately 66 hours.

Contraindications

  • Known hypersensitivity to vortioxetine or components.
  • Use with monoamine oxidase inhibitors (MAOIs) due to risk of serotonin syndrome.

Precautions

  • History of bipolar disorder, suicide risk, or seizures.
  • Consideration in patients taking other serotonergic drugs to prevent serotonin syndrome.

Adverse Reactions - Common

  • Nausea (11-20%)
  • Headache (10-20%)
  • Dizziness (5-10%)
  • Dry mouth (5-10%)

Adverse Reactions - Serious

  • Serotonin syndrome (Rare)
  • Hyponatremia (Rare)
  • Bleeding complications (Rare)
  • Suicidal thoughts or behaviors (Monitor especially early in treatment)

Drug-Drug Interactions

  • Serotonergic agents (e.g., SSRIs, SNRIs, triptans)

Drug-Food Interactions

N/A

Drug-Herb Interactions

  • St. John's Wort

Nursing Implications

Assessment: Monitor mental status, suicide risk, and for signs of serotonin syndrome.

Diagnoses:

  • Risk for injury related to adverse drug effects.
  • Impaired sleep related to medication effects.

Implementation: Administer as prescribed; monitor for adverse effects; educate patient on adherence.

Evaluation: Assess for improvement in depressive symptoms and adverse effects.

Patient/Family Teaching

  • Take medication as directed, even if feeling better.
  • Report any signs of serotonin syndrome (confusion, hallucinations, agitation).
  • Avoid alcohol and other CNS depressants.
  • Notify healthcare provider about all medications being taken.

Special Considerations

Black Box Warnings:

  • Suicidality in children, adolescents, and young adults with MDD or other psychiatric disorders.

Genetic Factors: Metabolized by CYP2D6; poor metabolizers may have higher drug levels.

Lab Test Interference: None documented.

Overdose Management

Signs/Symptoms: Dizziness, nausea, vomiting, somnolence, serotonin syndrome symptoms.

Treatment: Supportive care, activated charcoal if recent ingestion, monitoring of vital signs, and symptomatic treatment; no specific antagonist available.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions.

🛡️ 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.