Drug reference
Vortioxetine inhibits the re-uptake of serotonin (5-HT) and is an antagonist at 5-HT3 and an agonist at 5-HT1A receptors. This multimodal activity appears to be associated with antidepressant and anxiolytic-like effects.
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Major depression ▶BY MOUTH ▶Adult: Initially 10 mg once daily; adjusted according to response to 5–20 mg once daily ▶Elderly: Initially 5 mg once daily; increased if necessary up to 20 mg once daily
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Bleeding disorders. cirrhosis of the liver (risk of hyponatraemia). elderly (risk of hyponatraemia). history of mania (discontinue if patient entering manic phase). history of seizures. unstable epilepsy CAUTIONS, FURTHER INFORMATION ▶Seizures Discontinue treatment in patients who develop seizures or if there is an increase in seizure frequency. ▶Elderly Manufacturer advises caution when treating elderly patients with doses over 10 mg daily—limited information.
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NICE decisions ▶Vortioxetine for treating major depressive episodes (November 2015) NICE TA367 Vortioxetine (Brintellix ®) is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode. Patients currently receiving vortioxetine whose disease does not meet the above criteria should be able to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta367
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→Appendix 1: vortioxetine
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Nervous system ▶Common or very common Abnormal dreams. constipation. diarrhoea. dizziness. nausea. skin reactions. vomiting ▶Uncommon Flushing. night sweats ▶Frequency not known Angioedema. haemorrhage. hyponatraemia. neuroleptic malignant syndrome (discontinue immediately). serotonin syndrome (discontinue immediately)
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Manufacturer advises avoid unless potential benefit outweighs risk—toxicity in animal studies. If used during the later stages of pregnancy, there is a risk of neonatal withdrawal symptoms and persistent pulmonary hypertension in the newborn.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises caution in severe impairment (no information available).
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Manufacturer advises caution in severe impairment—limited information available.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Brintellix (Lundbeck Ltd) Vortioxetine (as Vortioxetine hydrobromide) 5 mg Brintellix 5mg tablets | 28 tablet P £27.72 DT = £27.72 Vortioxetine (as Vortioxetine hydrobromide) 10 mg Brintellix 10mg tablets | 28 tablet P £27.72 DT = £27.72 Vortioxetine (as Vortioxetine hydrobromide) 20 mg Brintellix 20mg tablets | 28 tablet P £27.72 DT = £27.72 3.5 Inappropriate sexual behaviour ANTIPSYCHOTICS › FIRST-GENERATION eiiii F 401
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Manufacturer advises treatment can be stopped abruptly, without need for gradual dose reduction.
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Driving and skilled tasks Manufacturer advises patients and carers should be counselled on the effects on driving and performance of skilled tasks, especially when starting treatment or changing the dose.
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Initially 10 mg once daily; adjusted according to
First-line fragment. Read the complete Indications and Dose section above.
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