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Tips for tapering vortioxetine / Trintellix / Brintellix

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erer   
erer

ADMIN NOTE

Please read this entire topic for tips about tapering vortioxetine.

 

There are many reports on the Web about withdrawal symptoms from vortioxetine, despite their being overlooked by drug companies.

 

Vortioxetine appears to have a withdrawal syndrome similar to almost all the antidepressants and should be tapered slowly to avoid severe or prolonged withdrawal symptoms. See Why taper by 10% of my dosage?

 

According to https://pubchem.ncbi.nlm.nih.gov/compound/vortioxetine#section=Top

 

Quote

Vortioxetine is an atypical antipsychotic and antidepressant indicated for the treatment of major depressive disorder (MDD). It is classified as a serotonin modulator and simulator (SMS) as it has a multimodal mechanism of action towards the serotonin neurotransmitter system whereby it simultaneously modulates one or more serotonin receptors and inhibits the reuptake of serotonin. More specifically, vortioxetine acts via the following biological mechanisms: as a serotonin reuptake inhibitor (SRI) through inhibition of the serotonin transporter, as a partial agonist of the 5-HT1B receptor, an agonist of 5-HT1A, and an antagonist of the 5-HT3, 5-HT1D, and 5-HT7 receptors. SMSs were developed because there are many different subtypes of serotonin receptors, however, not all of these receptors appear to be involved in the antidepressant effects of SRIs. Some serotonin receptors seem to play a relatively neutral or insignificant role in the regulation of mood, but others, such as 5-HT1A autoreceptors and 5-HT7 receptors, appear to play an oppositional role in the efficacy of SRIs in treating depression.

 

According to https://www.drugs.com/pro/brintellix.html , Brintellix is available as 

5mg

10mg

15mg

20mg

 

film-coated tablets. It has a very long half-life, somewhere around 66 hours. There is no ingredient in or coating on the tablet to make it extended-release, that would be unnecessary. (In May 2016, Takeda changed the name of this drug from Brintellix to Trintellix in the US to avoid confusion with another drug.)

 

SOLUBILITY -- MAKING YOUR OWN LIQUID

The active ingredient in the tablets, vortioxetine, is slightly soluble in water. This means you or a compounding pharmacy can make a liquid suspension from vortioxetine, see How to make a liquid from tablets or capsules

  • Brintellix is not soluble at all in water, so using a water titration you'll have a suspension not a consistent or "homeogenous" solution. 
  • It is highly soluble in a substance called DMSO, as are many psycho-neuro-active prescription medications. You can get oral or medical grade DMSO from many sources. If you want to use this and have questions about it, feel free to post them here.
    source: selleckchem.com

Measuring a drug for tapering by 10% at a time is easier using a liquid formulation. Since vortioxetine is available in fairly low dosages, you can take part of your daily dosage as a 5mg, 10mg, or 15mg tablet and add the rest as a liquid until your dosage is less than 5mg, where you would take your entire dose as a liquid. Taking part as a tablet and part as a liquid makes it easier to switch from a tablet to a liquid.

 

METABOLIZED BY LIVER ENZYME CYP 2D6

Vortioxetine is metabolized in the liver by several liver enzymes; however, enzyme cyp 2D6 is very important in its metabolization. Taking vortioxetine with other drugs that are metabolized in the liver, as many psychiatric drugs are, can lead to drug-drug interactions, particularly if the other drugs utilize cyp 2D6.

 

From https://pubchem.ncbi.nlm.nih.gov/compound/vortioxetine#section=Drug-and-Medication-Information

Quote

Vortioxetine has been associated with a low rate of minor serum aminotransferase elevations during treatment, but has not been linked to instances of clinically apparent acute liver injury.

 


 

I have a friend on vortioxetine (Brintellix) so I was wondering, does anyone have any info on how tapering this drug might look like?

Thanks in advance.

Edited by scallywag
added solubility details re: DMSO

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Lexy   
Lexy

I'm on Brintellix to help get me off effexor. Brintellix has a longer half life than effexor.

Even so I would still taper off at the recommended 10% rate.

When I'm done with effexor I will taper the brintellix. Can I ask how your friend is doing?

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erer   
erer

I'm on Brintellix to help get me off effexor. Brintellix has a longer half life than effexor.

Even so I would still taper off at the recommended 10% rate.

When I'm done with effexor I will taper the brintellix. Can I ask how your friend is doing?

She is not doing well - not feeling any effect from the medicine.

 

How are you planning to be doing the 10% cuts for those pills?

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Lexy   
Lexy

Personally I would start with 5-7% taper. You have become sensitized with all the pill switching you have gone through.

I would not want you to destabilize after the all the progress you have made to get to this point.

 

I'm on 3mg brintellix to help with effexor wds. My doctor who believes in withdrawals prescribed B to help buff out wd symptoms.

I will have to taper of that when I'm done with effexor. Please keep updating your taper journey.

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