Viibryd Tapering Guide
vilazodone
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Overview
Vilazodone is a selective serotonin reuptake inhibitor (SSRI) and partial agonist at the 5-HT1A receptor. It is used for the treatment of major depressive disorder.
10mg, 20mg, 40mg
Tablets: 10mg, 20mg, 40mg
Category C (risk cannot be ruled out)
Mechanism of Action
Combined SSRI activity with 5-HT1A receptor partial agonism, providing dual serotonergic modulation. Blocks SERT while partially activating 5-HT1A autoreceptors.
Taper Notes
Dual mechanism (SSRI + 5-HT1A partial agonist) and food-dependent absorption (~50% reduction without food) complicate tapering. No liquid formulation available; rely on tablet splitting. GI rebound is the predominant withdrawal pattern.
Maudsley Deprescribing Guidance
Reduce gradually over months. Initial 10 mg steps using available tablet strengths, transitioning to proportional ~10% reductions at lower doses. Compounded suspension may be needed for terminal doses given lack of commercial liquid.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated (risk of serotonin syndrome)
- Strong CYP3A4 inhibitors (ketoconazole) — reduce vilazodone dose to 20mg
- Serotonergic drugs (triptans, tramadol, St. John's Wort) increase serotonin syndrome risk
Food Interactions
- MUST be taken with food — bioavailability drops ~50% without food
- No specific food contraindications beyond the requirement to take with food
Contraindications
- MAOIs within 14 days
- Known hypersensitivity to vilazodone
Toxicity
Serotonin syndrome risk when combined with serotonergic agents. GI side effects are the most common dose-limiting toxicity.
Pharmacokinetics
ADME Profile
Oral bioavailability 72% with food (significantly reduced without food). Tmax ~4–5 hours. Must be taken with food.
Not well characterized; extensively distributed.
Hepatic via CYP3A4 (major), CYP2C19, and CYP2D6. Active metabolites are not clinically significant.
Primarily fecal (2% unchanged in urine).
96–99%
Apparent clearance ~40 L/hr
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