Names and pronunciation
(vil-az′oh-done) Viibryd
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Drug reference
(vil-az′oh-done) Viibryd
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Func. class.: Antidepressant V
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Chem. class.: SSRI, benzofuran
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ACTION: Novel antidepressant unre lated to other antidepressants, enhances serotonergic action by a dual mechanism
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USES: Major depression
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CONTRAINDICATIONS: Concomitant use of MAO inhibitors or within 14 days after discontinuing MAO inhibitor or within 14 days after discontinuing vilazodone Precautions: Pregnancy, labor, infants, geriatric patients, abrupt discontinua tion, bipolar disorder, bleeding, operat ing machinery, ECT, hepatic disease, hyponatremia, hypovolemia, substance abuse, history of seizures, serotonin syndrome, neuroleptic malignant syn drome; use with serotonin precursors or serotonergic drugs; suicidal ideation, worsening depression or behavior
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Black Box Warning: Children, suicidal ideation Black Box Warning: Mental status: orientation, mood, behavior initially and periodically; initiate suicide precautions if indicated; history of seizures, mania • Bleeding risk: assess for NSAIDs, ASA, anticoagulant use, check for bruising, black tarry stool, abdominal pain • Fracture risk: assess diet for cal cium, vitamin D; activity, bone density studies • Renal/hepatic status: hyponatremia (confusion, weakness, headache); moni tor serum sodium • Abrupt discontinuation: do not dis- continue abruptly, taper, monitor for symptoms of withdrawal; if intolerable, resume previous dose and decrease more slowly • Serotonin syndrome/NMS: nausea, vomiting, sedation, sweating, facial flush- ing, high B/P; discontinue product, notify prescriber change in mental status, sei- zures, rigidity; discontinue product, notify prescriber immediately • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; if used in 3rd trimester, fetal complications may occur; avoid breastfeeding, excreted in breast milk Black Box Warning: Suicidal thoughts/ behaviors: discuss with family the pos sibility of suicidal thoughts/behaviors and that prescriber should be notified imme diately if these occur • To notify prescriber if pregnancy is planned or suspected; to avoid breastfeeding HIGH ALERT
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SIDE EFFECTS CNS: Restlessness, dizziness, drowsiness, fatigue, mania, insomnia, migraine, neuro- leptic malignant syndrome–like reaction, paresthesias, seizures, suicidal ideation, tremors, night sweats, dream disorders CV: Palpitations, ventricular extrasystole EENT: Cataracts, blurred vision GI: Nausea, vomiting, flatulence, diar rhea, xerostomia, altered taste, gastro enteritis, increased appetite GU: Decreased libido, ejaculation disor der, increased frequency of urination, sexual dysfunction HEMA: Bleeding, decreased platelets INTEG: Sweating MS: Arthralgia, fracture SYST: Neonatal abstinence syndrome, withdrawal, serotonin syndrome
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INTERACTIONS Do not use within 2 wk of MAO inhibitors, linezolid, or methylene blue Increase: serotonin syndrome—SSRIs, SNRIs, serotonin receptor agonists, selegi- line, busPIRone, dextromethorphan, ergots, fenfluramine, dexfluramine, lithium, me peridine, fentaNYL, methylphenidate, dex- methylphenidate, metoclopramide, mirtazapine, nefazodone, pentazocine, phenothiazines, haloperidol, loxapine, thio- thixene, molindone, amphetamines Increase: bleeding—anticoagulants, thrombolytics, platelet inhibitors, salicy lates, NSAIDs Increase: vilazodone levels—CYP3A4 inhibitors (ketoconazole, erythromycin, efavirenz, dronedarone, clarithromycin and others) Decrease: vilazodone effect—CYP3A4 inducers (carBAMazepine) Drug/Food • Avoid use with grapefruit juice Drug/Herb Increase: serotonin syndrome—St. John’s wort Drug/Lab Test Decrease: sodium
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DOSAGE AND ROUTES Major depressive disorder • Adult: PO 10 mg × 7 days, then 20 mg × 7 days, then 40 mg/day; if taking potent CYP3A4 inhibitor, max 20 mg/ day; potent CYP3A4 inducer increase dose up to double may be needed, max 80 mg/day
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Available forms: Tabs 10, 20, 40 mg
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Administer: • With food to increase absorption • Do not use within 2 wk of MAOIs • Missed dose should be taken as soon as possible, unless it is almost time for next dose; do not double • Store at room temperature, away from moisture, heat
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Assess:
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Evaluate: • Therapeutic response: remission of depressive symptoms, decreased anxi ety
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take as directed, with food, not to double dose, follow-up will be needed • To avoid abrupt discontinuation unless approved by prescriber • Not to drive or operate machinery until effects are known • Not to use other products unless approved by prescriber, do not use alcohol • To contact prescriber for allergic re- actions; personality changes (aggression, anxiety, anger, hostility); extreme sleepi- ness confusion, nervous, restless, or clumsy; numbness, tingling, burning pain in hands, arms, legs, or feet; tremors; unusual behavior or thoughts about hurt- ing oneself
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PHARMACOKINETICS Protein binding 96%-99%, metabolized by liver by CYP3A4 (major) and CYP2C19 and CYP2D (minor) and non-CYP path ways, peak 4-5 hr, half-life 25 hr
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• Adult: PO 10 mg × 7 days, then 20 mg × 7 days, then 40 mg/day; if taking potent CYP3A4 inhibitor, max 20 mg/ day; potent CYP3A4 inducer increase dose up to double may be needed, max 80 mg/day
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