Names and pronunciation
(vor′tye-ox′e-teen) Brintellix
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Drug reference
(vor′tye-ox′e-teen) Brintellix
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Func. class.: Antidepressant
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Chem. class.: Serotonin modulator
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Do not confuse: V Brintellix/ Brilinta
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ACTION: Reuptake inhibition at the serotonin transporter and agonist, or antagonist effects at serotonin receptors
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USES: Major depressive disorder in adults
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CONTRAINDICATIONS: Hyper sensitivity, MAOI therapy Precautions: Pregnancy, breastfeeding, seizure disorder, bipolar disorder, hypo natremia, hypovolemia, abrupt discon tinuation, anticoagulant therapy, bleed ing, closed-angle glaucoma, geriatric patients, hepatic disease
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Black Box Warning: Children, suicidal ideation Black Box Warning: Mental status: mood, sensorium, affect, suicidal tenden cies, increase in psychiatric symptoms, depression, panic • Serotonin syndrome: increased heart rate, sweating, dilated pupils, tremors, twitching, hyperthermia, agitation • Alcohol consumption; if alcohol is consumed, hold dose until AM • Sexual dysfunction: impotence • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; do not breastfeed Black Box Warning: That suicidal ideas, behaviors may occur in children or young adults • To notify prescriber if pregnant, plan- ning to become pregnant, or breastfeeding Black Box Warning: About the effects of serotonin syndrome: nausea/vomiting, tremors; if symptoms occur, to discon tinue immediately, notify prescriber
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SIDE EFFECTS CNS: Flushing, mania, serotonin syn drome, vertigo, dizziness, suicidal attempts GI: Nausea, diarrhea, dyspnea, constipa tion, vomiting, flatulence GU: Impotence, ejaculation/orgasm dysfunction INTEG: Pruritus SYST: Serotonin syndrome, neonatal absti- nence syndrome, angioedema, pulmonary hypertension of the newborn, SIADH
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INTERACTIONS Increase: effect of tricyclics; use cautiously Increase: serotonin syndrome—sero- tonin receptor agonists, SSRIs, traMADol, lithium, MAOIs, traZODone, SNRIs (venla- faxine, DULoxetine) Increase: bleeding risk—NSAIDs, salicy lates, thrombolytics, anticoagulants, antiplatelets Increase: CNS effects—barbiturates, seda tive/hypnotics, other CNS depressants Decrease: vortioxetine levels—carBAMaz epine Drug/Herb: Increase: serotonin syndrome—St. John’s wort
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DOSAGE AND ROUTES • Adult: PO 10 mg/day, may start with 5 mg/day initially, increase to 20 mg/day as tolerated, max 20 mg/day; poor metabo lizers of CYP2D6 max 10 mg/day
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Available forms: Tabs 5, 10, 20 mg
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Administer: Without regard to food
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Assess:
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Evaluate: • Therapeutic response: decreased de pression
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That therapeutic effect may take sev eral weeks • That decrease in libido or impotence may occur • To use caution when driving, performing other activities that require alertness be cause of drowsiness, dizziness, blurred vi sion; to report signs, symptoms of bleeding • To avoid alcohol, other CNS depres sants
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PHARMACOKINETICS Protein binding 98%, excreted in urine (59%), feces (26%)
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• Adult: PO 10 mg/day, may start with 5 mg/day initially, increase to 20 mg/day as tolerated, max 20 mg/day; poor metabo lizers of CYP2D6 max 10 mg/day
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