Vortioxetine


Concise Prescribing Info
Indications/Uses
Major depressive disorder
Dosage/Direction for Use
Adult : PO Initial: 10 mg once daily, may be increased up to 20 mg once daily or decreased to 5 mg once daily according to patient response.
Dosage Details
Oral
Major depressive disorder
Adult: Initially, 10 mg once daily, may be increased up to 20 mg once daily or decreased to 5 mg once daily according to patient response.
Elderly: Initially, 5 mg once daily, increased to 10 mg once daily if tolerated.
Special Patient Group
Patient taking strong CYP2D6 inhibitor (e.g. bupropion, quinidine, fluoxetine, paroxetine): Reduce to half of the usual dose. May increase to usual dose when CYP2D6 inhibitor is discontinued.

Patient taking CYP450 inducer (e.g. rifampicin, carbamazepine, phenytoin) for >14 days: Max dose should not exceed 3 times the original dose. May reduce to usual dose within 14 days when CYP450 inducer is discontinued.

Pharmacogenomics:

CYP2D6 is the main enzyme involved in the metabolism of vortioxetine to its major, inactive, carboxylic acid metabolite. CYP2D6 gene polymorphism may affect the safety and effectiveness of vortioxetine.

CYP2D6 poor metabolisers, individuals who lack CYP2D6 enzymes have approx twice the plasma concentration of vortioxetine than normal metabolisers. Product guidelines recommend max daily dose of 10 mg in CYP2D6 poor metabolisers. Concomitant use of strong CYP3A4/2C9 inhibitors in poor metabolisers may also result in higher vortioxetine plasma concentration.
Administration
May be taken with or without food.
Contraindications
Concomitant or within 14 days of discontinuing MAOI therapy (e.g. linezolid, IV methylene blue).
Special Precautions
Patient with history of suicide-related events or pre-existing suicidal ideation; family history of bipolar disorder, mania or hypomania; seizure disorders or unstable epilepsy; bleeding disorders, cirrhosis, narrow-angle glaucoma (without undergoing iridectomy). Elderly. Pregnancy and lactation. CYP2D6 poor metabolisers. Patient taking strong CYP2D6 inhibitors or strong CYP450 inducers.
Adverse Reactions
Significant: Worsening of depression, mania or hypomania, angle-closure glaucoma, seizures, fractures, hyponatraemia.
Gastrointestinal disorders: Nausea, diarrhoea, constipation, vomiting, flatulence, dry mouth.
Nervous system disorders: Dizziness.
Psychiatric disorders: Abnormal dreams.
Skin and subcutaneous tissue disorders: Pruritus.
Potentially Fatal: Neuroleptic malignant syndrome, serotonin syndrome, haemorrhage, suicidal ideation and behaviour.
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor for clinical worsening, emergence of suicidal thoughts or behaviours and unusual changes in behaviour. Monitor for signs and symptoms of serotonin syndrome and hyponatraemia.
Overdosage
Symptoms: Nausea, vomiting, postural dizziness, diarrhoea, abdominal discomfort, generalised pruritus, somnolence, flushing, seizure, serotonin syndrome. Management: Symptomatic treatment and relevant monitoring.
Drug Interactions
Increased serum concentration with strong CYP2D6 inhibitors (e.g. bupropion, quinidine, fluoxetine, paroxetine). May increase risk of bleeding with anticoagulants (e.g. warfarin), antiplatelet drugs (e.g. aspirin) or NSAIDs. Concomitant use of drugs with potential of lowering seizure threshold e.g. antidepressants (tricyclics, SNRI), neuroleptics (phenothiazines, thioxanthenes, butyrophenones), mefloquine, bupropion, and tramadol may increase risk of seizure.
Potentially Fatal: Increased risk of serotonin syndrome with serotonergic agents (e.g. triptans, TCAs, fentanyl, lithium, tramadol, buspirone, tryptophan) or agents that impair the metabolism of serotonin (e.g. MAO inhibitors including linezolid and IV methylene blue).
Food Interaction
May increase risk of adverse reactions (e.g. serotonin syndrome) with St. John’s wort.
Action
Description: Vortioxetine is an antidepressant that inhibits reuptake of serotonin (5-HT) leading to enhanced serotonergic activity in the CNS. It also has antagonist activity at the 5-HT3 and agonist activity at 5-HT1A receptors.
Pharmacokinetics:
Absorption: Bioavailability: 75%. Time to peak plasma concentration: 7-11 hours.
Distribution: Volume of distribution: 2,600 L. Plasma protein binding: 98%.
Metabolism: Extensively metabolised in the liver by CYP450 isoenzymes, mainly CYP2D6, via oxidation and further metabolised via glucuronic acid conjugation to an inactive carboxylic acid metabolite.
Excretion: Via urine (59%); faeces (26%) as metabolites. Elimination half-life: Approx 66 hours.
Chemical Structure

Click on icon to see table/diagram/image
Storage
Store below 30°C.
MIMS Class
ATC Classification
N06AX26 - vortioxetine ; Belongs to the class of other antidepressants.
Disclaimer: This information is independently developed by MIMS based on Vortioxetine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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