Vortioxetine ($ Trintellix)
Antidepressant (Serotonin reuptake inhibitor (SERT), receptor partial agonist (5-HT1A), receptor antagonist (5-HT3))
- Major Depression (improves cognition)1
- Schizophrenia negative symptoms2
- Mild cognitive benefit in depression and age-related cognitive decline
Features
Dosing
10-20 mg qd. May want to start low (5 mg qod) to prevent nausea (or pretreat with ginger or onadansetron).
INTERACTIONS: Lower 50% with strong CYP2D6 inhibitors (asenapine, bupropion, cannabidiol, duloxetine, and non-pram SSRIs: fluoxetine, paroxetine, sertraline ≥ 150 mg/day).
Management
Main side effect is nausea (start 5mg every other day to avoid it). Improves cognition (specifically, Digit Symbol Substitution Test). Low rate of sexual side effects.
Mechanism of action resembles that of buspirone, lavender, and some antipsychotics (5-HT1A).
EMR Text
Depression
Vortioxetine use based on FDA approval in depression.
Vortioxetine’s side effects reviewed with patient.
Schizophrenia
Vortioxetine use based on controlled trial of negative symptoms in schizophrenia.
Vortioxetine’s side effects reviewed with patient.
Cognition
Vortioxetine use based on controlled trials in cognition, including trials in depression and age related cognitive decline.
Vortioxetine’s side effects reviewed with patient.