Medications: Viibryd ^® – vilazodone

VIIBRYD is indicated for the treatment of major depressive disorder (MDD) in adults (1).

DOSAGE AND ADMINISTRATION

• Recommended target dosage: 20 mg to 40 mg once daily with food (2.1, 12.3)
• To titrate: start with initial dosage of 10 mg once daily for 7 days, followed by 20 mg once daily. The dose may be increased up to 40 mg once daily after a minimum of 7 days between dosage increases (2.1)
• Prior to initiating VIIBRYD, screen for bipolar disorder (2.2, 5.4)
• When discontinuing VIIBRYD, reduce dosage gradually (2.4, 5.5)

Most common adverse reactions (incidence ≥ 5% and at least twice the rate of placebo): diarrhea, nausea, vomiting, and insomnia (6).

Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs (4)

WARNINGS AND PRECAUTIONS:

• Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents (e.g., SSRI, SNRI, triptans, amphetamines), but also when taken alone. If it occurs, discontinue VIIBRYD and initiate supportive treatment (5.2)
• Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), other antiplatelet drugs, warfarin, and other anticoagulants may increase this risk (5.3)
• Activation of Mania/Hypomania: Screen patients for bipolar disorder (5.4).
• Seizures: Can occur with treatment. Use with caution in patients with a seizure disorder (5.6).
• Angle Closure Glaucoma: Avoid use of antidepressants, including VIIBRYD, in patients with untreated anatomically narrow angles. (5.7)

• CYP3A4 Inhibitors: The VIIBRYD dose should not exceed 20 mg once daily when co-administered with strong CYP3A4 inhibitors (2.4, 7).
• CYP3A4 Inducers: Consider increasing VIIBRYD dosage by 2-fold, up to 80 mg once-daily over 1 to 2 weeks when used concomitantly with strong CYP3A4 inducers for greater than 14 days (2.4, 7)

There is limited clinical trial experience regarding human overdose with VIIBRYD. The adverse reactions associated with overdose of VIIBRYD at doses of 200-280 mg (5 to 7 times the recommended dosage) as observed in clinical trials included serotonin syndrome, lethargy, restlessness, hallucinations, and disorientation.

For current information on the management of poisoning or overdose, contact a poison control center at 1-800-222-1222. No specific antidotes for vilazodone are known. Removal of vilazodone by dialysis has not been studied; however, the high volume of distribution of vilazodone suggests that dialysis will not be effective in reducing vilazodone plasma concentrations.