Vortioxetine

About Vortioxetine

Vortioxetine acts on serotonin in several ways: it blocks serotonin reuptake and also acts on a number of serotonin receptors. The label approves it for major depressive disorder in adults; it is not approved for children. The usual start is 10 mg once a day, raised to 20 mg as tolerated, and 5 mg is used for people who cannot tolerate higher doses; doses above 20 mg have not been evaluated in controlled trials. It is taken with or without food. People known to be poor metabolizers through the liver enzyme CYP2D6 take no more than 10 mg a day, the dose is halved while a strong CYP2D6 inhibitor is taken, and with a strong enzyme inducer such as rifampin taken for more than 14 days the prescriber may raise the dose, to no more than three times the original. The full benefit can take several weeks or longer.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in children, adolescents and young adults up to age 24 in short-term studies, so anyone starting treatment or changing dose is watched for worsening mood, agitation or unusual behavior. Vortioxetine must not be taken with a monoamine oxidase inhibitor: 14 days must pass after stopping an MAOI before starting it, and 21 days after stopping vortioxetine before starting an MAOI, and it is not started in anyone taking linezolid or intravenous methylene blue. Other warnings cover serotonin syndrome, especially with triptans, tramadol, St. John’s wort or other serotonergic drugs; bleeding, more so with NSAIDs, aspirin or anticoagulants; triggering mania; angle-closure glaucoma; low sodium; and sexual dysfunction. Nausea, constipation and vomiting were the most common side effects, and MedlinePlus adds unusual dreams and sexual problems.

What is distinctive is how it is stopped: abrupt discontinuation from 15 mg or 20 mg can cause temporary symptoms such as headache, irritability or dizziness, so the dose is lowered to 10 mg for a week first where possible. Human data in pregnancy are limited; serotonergic antidepressants taken late in pregnancy can cause problems in the newborn, and use in the month before delivery may be linked to bleeding after birth, so the risks are discussed and a pregnancy registry is available. Alcohol can make side effects worse, and MedlinePlus advises not driving until you know how it affects you. Vortioxetine is not a controlled substance.

Taking Vortioxetine

How to take it

Take one tablet by mouth once a day, with or without food, at about the same time each day. Keep taking it even if you do not feel better yet, and do not stop without talking to the prescriber, who will usually lower the dose first.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

In the original tightly closed container at room temperature, away from heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Never with a monoamine oxidase inhibitor, and not started with linezolid or intravenous methylene blue. Strong CYP2D6 inhibitors such as bupropion, fluoxetine, paroxetine and quinidine call for half the dose; rifampin, carbamazepine and phenytoin lower its level. NSAIDs, aspirin and warfarin raise the bleeding risk, and triptans, tramadol, tryptophan and St. John’s wort add to the risk of serotonin syndrome. Alcohol can make side effects worse.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Vortioxetine differs from pharmacy to pharmacy

Vortioxetine is priced as a brand, so quotes differ mainly by the pharmacy’s markup and whether it stocks the strength written; the three strengths are separate products, and a dose change from 10 mg to 20 mg is a new quote, not a doubled one.

The dose is one tablet a day, so a month is thirty tablets and a ninety-day fill is one dispensing fee instead of three. Because no generic is on the market, the maker’s assistance programs matter more here than for most antidepressants.

Ways to pay less for Vortioxetine without insurance

• Ask the maker whether its savings or patient assistance program applies to someone paying cash; many copay cards require commercial insurance, so ask rather than assume.
• Compare more than one pharmacy for the exact strength and count written, since markups on a brand differ.
• Once your dose is settled, ask the prescriber whether a ninety-day supply suits you, so you pay fewer dispensing fees.
• If the brand is out of reach, ask the prescriber whether a generic antidepressant would suit you; several SSRIs and SNRIs are generics, but the choice is the prescriber’s, never a pharmacy swap.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Vortioxetine

1. 1.Do any of my medicines, such as bupropion, fluoxetine, quinidine, rifampin, an NSAID or a blood thinner, change how my vortioxetine works or my dose?
2. 2.Which mood changes should my family and I watch for in the first weeks and after a dose change?
3. 3.If I need to stop vortioxetine, how should the dose come down?
4. 4.Does the pharmacy keep my strength in stock, and can I fill ninety days at a time?

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