Vortioxetine (Oral)

Vortioxetine is thought to be the first antidepressant that treats not only the main symptoms of major depressive disorders but also cognitive functions especially in regards to depression.

Overview

Depression usually has various symptoms. Patients often experience a loss of interest in daily activities, fatigue, sadness, anger, and loss of appetite, to name some. It is thought to be caused by an imbalance in serotonin, which is a chemical produced by the body's nerve cells, and which regulates several functions in the body. These include mood, energy, sleep and sexual function, among others. Depression can also cause a loss in cognitive functions, or mental fog, that makes it hard for a patient to concentrate or think.

Vortioxetine is thought to be able to treat both depression and cognitive function as it interacts with different brain chemicals and receptors. It differs from other SSRIs in being able to inhibit serotonin reuptake and transport on several modes; it also differs in that it is able to affect neurotransmitters which in turn affect cognitive function, an area of depressive disorders that has proven difficult to treat with current SSRIs on the market.

It is hoped that with vortioxetine, patients will recover energy, mental clarity, and an interest in daily life again.

Conditions treated

  • Depression
  • Cognitive dysfunction in depression

Type of medicine

  • SSRI

Side Effects

Not everyone who takes vortioxetine will encounter side effects, although some patients do. While the majority of patients will experience at most little of the side effects, or even none at all, the most common complaints are:

  • Headaches
  • Nausea
  • Diarrhea
  • Constipation
  • Lack of sexual desire or sexual dysfunction

Nausea is more commonly reported in female patients, and with patients who are above 65 years of age.

Some less frequent side effects are:

  • Mouth dryness
  • Dizziness
  • Itching
  • Problems with gas, such as feeling bloated or having an upset stomach.

These are milder side effects that may disappear as the patient adjusts to the medication. However if they persist or get worse, the patient should alert the doctor and ask for medical advice.

More serious side effects that require a doctor's attention include:

  • Tremors
  • Restlessness
  • Numbness and/or tingling
  • Difficulties with concentration
  • Memory problems
  • Weakness
  • Abnormal bleeding or bruising

If the patient experiences any of the following severe side effects, they should seek medical help immediately:

  • Seizures
  • Black stools
  • Eye problems (eye pain, swelling, or sensitivity, or vision changes such as blurred vision)
  • Vomit that looks like coffee grounds
  • Serotonin syndrome
  • Manic episodes
  • Low blood sodium
  • Signs of an allergic reaction (for example, trouble breathing, rashes, swelling of skin around the face)

Low blood sodium and abnormal bleeding/bruising should be looked at especially as they can be fatal if left untreated. This is not an exhaustive list of side effects that may occur with the use of vortioxetine. If the patient experiences any unusual symptom or problem during the course of treatment, they should talk to their doctor as soon as possible about them.

Dosage

Vortioxetine should only be taken as indicated by a physician. It is normally taken once a day, with or without food, and it is recommended to take the medication at around the same time each day. The patient should not take more or less than has been prescribed, nor should it be taken more often than instructed. Misuse in this manner will not result in faster recovery, but it is conversely likely to increase the chances of side effects.

A medication guide should be provided with each prescription and refill of vortioxetine. It is imperative to read it thoroughly the first time the patient gets it, preferably again when there is a refill, and to ask the physician or pharmacist if they do not understand anything in the guide.

The doctor will often prescribe a low dosage for initial use in adults to reduce the odds of having side effects from the medication. This may start at a dose of 10 milligrams (mg) and will be adjusted over the course of several weeks. The maximum dose that can be consumed is 20mg per day. Maintenance doses, once the patient is used to the medication, ranges from 5mg to 20mg. The patient's dosage will vary based on a number of factors. Existing medical condition, interaction with any other drugs that may be in current use, and also the patient's response to the vortioxetine will affect how much the doctor decides is necessary for a daily dose.

If patients miss one dose, they should take another dose on the next day. They should not take a double dose to make up for it. If more than one dose has been skipped, it is advised to contact the doctor for instructions on how to proceed. Should the patient suspect an overdose, they should also ask their doctor for further advice, and to be prepared with information such as usual dosage, number of medication left and other relevant facts.

Decreasing the dosage or stopping medication abruptly may cause headaches and muscle tension, or mood swings. It is recommended to stop vortioxetine by lowering the dosage gradually, and with a doctor's guidance. The patient is advised not to stop their treatment abruptly even if they are feeling well. Improvement in symptoms may take some weeks to show, with varying effects on the various symptoms of depression.

Vortioxetine has currently only been approved for use in adults over 18.

Interactions

Vortioxetine should not be combined with other drugs, whether they are prescription or non-prescription, or herbal products, without first consulting a doctor. The ensuing interactions may affect how vortioxetine works, and they also may increase the risk of side effects. If the patient plans on starting or stopping any form of medication, whether it's vortioxetine or another drug, they are advised to consult a doctor or pharmacist. It is also necessary for the patient to keep a list of products that they are using so they can show it to their healthcare providers in the case of medication incompatibility.

Drugs that boost serotonin levels should not be taken in conjunction with vortioxetine, as they increase the risk of a syndrome known as serotonin toxicity. It is a serious but rare condition that may be noted by symptoms like nausea, vomiting, muscle spasms/stiffness, stomach cramps, confusion, blood pressure changes and hallucinations. Acute cases may lead to coma or even death. Examples of these drugs are certain cough syrups, street drugs such as ‘Ecstacy' (or MDMA/Molly), and herbal products like St. John's Wort.

Usage of monoamine oxidase inhibitors (MAOIs, or MAO inhibitors) may cause a severe and possibly deadly interaction with vortioxetine. Examples of MAO inhibitors are isocarboxazid, phenelzine and selegiline. Approach your doctor for advice on when to start or stop this medication, especially when considering use of vortioxetine. Generally, MAO inhibitors should not be used within 14 days of starting vortioxetine, or 21 days after ending use.

Medications that increase risk of bleeding and bruising may interact with vortioxetine; these include drugs such as clopidogrel, ibuprofen and warfarin. Another drug that may cause increased bleeding is aspirin. However low dosage aspirin is sometimes used to prevent heart attacks or strokes. If the patient has been prescribed aspirin, they should ask their doctor for more details regarding their condition and how vortioxetine will impact current medication and symptoms.

You can find a non-exhaustive list of drug interactions with vortioxetine here.

Warnings

Prior to starting the medication, the patient should notify their physician about any allergies they may have, as well as allergy to vortioxetine. This is to prevent allergic reactions to the medication itself, as well as any inactive ingredients that are used. It is useful to list what reactions the patient has had with their allergies, like rashes, hives or swelling, for example. The patient should also take care to let their doctor know of any history of illness, whether personal or among the family. These include, but are not limited to: bipolar disorders, depression, seizures, intestinal ulcers and angle-closure glaucoma.

Children, teenagers and young adults may experience an initial worsening of symptoms and mood in the first weeks of their use of antidepressants before they improve. Patients with personal or family history of mental illness are at higher risk. It is important to pay close attention to younger persons who are taking antidepressants and to ask for medical assistance if there are any negative changes in mood, behavior, and emotion, or if sleep patterns are disrupted.

For pregnant patients, or those who are planning on pregnancy, vortioxetine should only be prescribed if clearly needed as it can cause harm to fetuses and infants. Currently, there is insufficient information on how vortioxetine affects human fetuses. Infants born to patients who have used vortioxetine in the last trimester occasionally exhibit signs of withdrawal, such as difficulties in feeding and breathing, muscle tension, seizures or continuous crying. Breastfeeding while on vortioxetine is discouraged as it is not known whether the drug passes into breast milk, and the patient should choose whether to discontinue the medication or breastfeeding.

Vortioxetine may cause dizziness. Do not use if the patient is required to be alert while performing activities such as driving or operating heavy machinery.

Alchoholic beverages should not be consumed together with vortioxetine.

Older patients, especially if 65 years old and above, may be at increased risk for side effects. They are also at risk of developing hyponatremia, which is a low level of sodium in the blood, especially if taking diuretics with vortioxetine.

If the patient will be undergoing surgery, it is necessary to inform their doctors of any drugs or products they are taking.

Storage

Vortioxetine should be stored in a cool, dry area at room temperatures, usually from 59°F to 86°F, out of the reach of children or animals. Do not store in the bathroom as it may be too humid or too warm. Improper storage of medication may cause it to change properties or become less effective.

If the patient and doctor decide to stop treatment, excess medication should be disposed of properly, and especially so that children or animals will not accidentally consume it. Vortioxetine should not be flushed down the toilet. It is recommended to ask a pharmacist or local waste management about proper medicine disposal in the patient's area.

Summary

Vortioxetine is an SSRI which is used to treat major depressive disorders. It helps to alleviate depressive symptoms such as a downward turn in mood, low energy, and insomnia. Compared to other SSRIs, vortioxetine is also thought to treat cognitive dysfunction, independently of depressive symptoms. It is able to interact with serotonin transport and inhibition of its uptake on several modes.

The dosage for the medication should be followed strictly according to a doctor's prescription, so as to lessen the risk of side effects; such effects can more commonly include nausea, headache and sexual dysfunction. If any serious side effects such as seizures or black stools occur, the patient should seek medical help immediately. Nevertheless, the majority of patients are expected to experience little to none of the side effects of the medication.

Vortioxetine is not recommended for persons under 18 years of age or for pregnant people. The effects of vortioxetine on fetuses and infants is as of now limited. There may be withdrawal effects on infants born to patients with vortioxetine usage in the last trimester. Breastfeeding while on vortioextine is discouraged due to insufficient information on the passing of the drug to breast milk.

As vortioxetine may cause dizziness and tiredness, patients should not engage in activities that require mental alertness, such as driving or operating machinery. The consumption of alcohol while on medication should be consulted with the patient's doctor, and is generally discouraged.

The medication may take some weeks to show any noticeable improvement, but the patient should continue taking vortioxetine unless otherwise directed by their physician. Sticking with the prescription is of utmost importance to recovery. Generally, physical symptoms take around two weeks to be alleviated, and full improvement may take up to six or eight weeks.

While it has a fairly long list of possible side effects, vortioxetine is prescribed if the doctor feels that the positive effects outweighs these negatives. When taken correctly, vortioxetine helps patients to resume a healthy, active life that may otherwise be impeded by depression.

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Last Reviewed:
December 22, 2017
Last Updated:
April 05, 2018
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