Vortioxetine: Difference between revisions

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{{MedTemplate

~~| generic = Vortioxetine~~

| brand = Trintellix (US), Brintellix (formerly)

| brand = Trintellix

| classes = Multimodal antidepressant: SERT inhibitor + 5HT1A agonist + 5HT1B partial agonist + 5HT3/5HT7 antagonist

~~| structure =~~

| mechanism = Sometimes called a 'serotonin modulator and stimulator.' Combines: SERT inhibition (raises 5-HT) + direct 5HT1A receptor agonism + 5HT1B partial agonism (heteroreceptor) + 5HT3, 5HT7, 5HT1D antagonism. Net effect: increased 5-HT, NE, DA, ACh, histamine, glutamate via disinhibition of multiple downstream circuits. Stahl emphasizes the 5HT3 antagonism + 5HT7 antagonism for the pro-cognitive effects.

| classes = ~~Antidepressant~~

| uses = Major depressive disorder in adults (FDA-approved 2013). Notable for evidence of cognitive benefit (processing speed) that distinguishes it from other antidepressants.

| mechanism = ~~Multimodal serotonergic agent~~

| starting_dose = 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed

| uses =

| preparations = 5 mg, 10 mg, 20 mg tablets

| starting_dose =

| fda_max = 20 mg/d

| preparations =

| routes = Oral

| fda_max =

| onset = Typical antidepressant 4-6 week onset

| routes =

| duration = Daily dosing

| onset =

| halflife = ~66 hours

| duration =

| bioavailability = ~75%

| halflife =

| pregnancy = Limited data; weigh benefits/risks

| bioavailability =

| legal = Rx

| pregnancy =

| intro = '''Vortioxetine''' (brand name Trintellix in the US, formerly Brintellix) is a multimodal antidepressant FDA-approved in 2013 for major depressive disorder. Beyond SERT inhibition, it directly modulates multiple serotonin receptor subtypes: 5HT1A agonism, 5HT1B partial agonism, and 5HT3, 5HT7, and 5HT1D antagonism. This combination produces, via disinhibition, downstream increases in not only serotonin but also norepinephrine, dopamine, acetylcholine, histamine, and glutamate, the hypothesized basis for its '''pro-cognitive effects''' (improved processing speed) that have distinguished it in trials of MDD with cognitive symptoms.

| legal =

| intro =

The ondansetron-like 5HT3 antagonism reduces the GI side effects common to pure SSRIs (less nausea than typical SERT inhibitors). Sexual side effects appear to be lower than with SSRIs but still occur.

~~| pharmacokinetics =~~

| pharmacodynamics= SERT inhibition + 5HT1A agonism + 5HT1B partial agonism + 5HT3, 5HT7, 5HT1D antagonism. The 5HT3 antagonism (similar to ondansetron) may underlie reduced GI side effects. The 5HT7 antagonism may underlie pro-cognitive effects.

| pharmacodynamics =

| effects = Nausea (most common; less than typical SSRIs), constipation, vomiting, sexual dysfunction (less than SSRIs but present). Lower rate of discontinuation symptoms due to long half-life.

~~| indications =~~

| interactions = <pharmaInteractions/>

~~| dosing~~ =

| effects =

| interactions = <pharmaInteractions/>

~~| pregnancy_details =~~

~~| monitoring =~~

~~| counseling =~~

~~| anecdotes =~~

~~| seealso =~~

~~| references =~~

}}

[[Category:Antidepressants]]

[[Category:Multimodal Serotonergic Agents]]

[[Category:Multimodal Antidepressants]]

MDElliottMD (talk | contribs)