Doctor of Pharmacy Reviews Trintellix (Vortioxetine, Brintellix)

Summary:

Introduction and Use:
- Vortioxetine (Trintellix) is a newer antidepressant with a unique mechanism of action, distinguishing it from older antidepressants.
- It is primarily approved for treating depression, though sometimes prescribed off-label for anxiety.
Mechanism of Action:
- Vortioxetine has a multimodal mechanism, inhibiting serotonin reuptake and directly binding to serotonin receptors, enhancing overall serotonergic signaling.
Efficacy and Side Effects:
- Vortioxetine's efficacy is comparable to other antidepressants, showing modest improvement over placebo.
- Common side effects include nausea, vomiting, dry mouth, diarrhea, itchiness, abnormal dreams, and dizziness. Sexual dysfunction affects about 1 in 10 patients, but it's believed to cause fewer side effects than other serotonergic drugs.
Warnings and Interactions:
- Discontinuation can lead to symptoms like irritability and trouble sleeping. Rare but serious side effects include increased suicidal ideation risk, bleeding risk (especially when combined with certain anti-inflammatory drugs), serotonin syndrome risk, and potential exacerbation of bipolar disorder's manic phase.
Cost and Alternatives:
- Vortioxetine is patented and can be expensive without insurance. Cheaper alternatives like escitalopram, citalopram, and bupropion are available and are generally as effective, differing mainly in side effects.