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Viibryd
vilazodone
Black Box Warnings .
Suicidality
antidepressants incr. suicidality risk in peds and young adult pts in short-term studies; monitor closely for clinical worsening and suicidality; advise families and caregivers of need for close observation and communication w/ prescriber; not approved for peds pts
Adult Dosing .
Dosage forms: TAB: 10 mg, 20 mg, 40 mg; convenience pack
Special Note
- [convenience pack components]
- Info: 30-day starter pack contains 10 mg tab x7 and 20 mg tab x23
major depressive disorder
- [20-40 mg PO qd]
- Start: 10 mg PO qd x7 days, then 20 mg PO qd, then may incr. dose no more frequently than q7 days; Info: give w/ food; taper 40 mg/day dose to 20 mg/day x4 days, then 10 mg/day x3 days to D/C; taper 20 mg/day dose to 10 mg/day x7 days to D/C
renal dosing
- [see below]
- CrCl >15: no adjustment; CrCl <15: not defined
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- MAO inhibitor use w/in 14 days
- abrupt withdrawal
- caution: pts <25 yo
- caution: elderly pts
- caution: volume depletion
- caution: seizure disorder
- caution: bipolar disorder
- caution: hypomania hx
- caution: mania hx
- caution: glaucoma, angle-closure
- caution: bleeding risk
Drug Interactions .
Overview
vilazodone
serotonin modulator
- CYP3A4 substrate
- P-gp inhibitor, weak
- antiplatelet effects
- CNS depression
- hyponatremia
- lowers seizure threshold
- serotonergic effects
- add MAO inhibitor to Interaction Check if recent (14 days) use
Contraindicated
- isocarboxazid
- linezolid
- methylene blue injection
- phenelzine
- selegiline transdermal
- tranylcypromine
Avoid/Use Alternative
- 5-HTP
- aldesleukin
- alfentanil
- almotriptan
- amifampridine
- amitriptyline
- amoxapine
- amphetamine
- bromocriptine
- buprenorphine
- bupropion
- buspirone
- butalbital
- butorphanol
- carbamazepine
- ceritinib
- citalopram
- clomipramine
- cocaine
- codeine
- cyclobenzaprine
- desipramine
- desvenlafaxine
- dexmethylphenidate
- dextroamphetamine
- dextromethorphan
- dihydrocodeine
- dihydroergotamine
- doxepin
- doxepin topical
- doxylamine
- duloxetine
- edoxaban
- eletriptan
- enoxaparin
- ergotamine
- escitalopram
- ethanol
- fenfluramine
- fentanyl
- fluoxetine
- fluvoxamine
- fondaparinux
- frovatriptan
- gepirone
- granisetron
- hydrocodone
- hydromorphone
- imipramine
- iohexol
- isoniazid
- kava
- kratom
- lasmiditan
- levomilnacipran
- levorphanol
- lisdexamfetamine
- lithium
- meperidine
- metaxalone
- methadone
- methamphetamine
- methylene blue oral
- methylergonovine
- methylphenidate
- metoclopramide
- midazolam
- milnacipran
- mirtazapine
- morphine
- nalbuphine
- naratriptan
- nefazodone
- netupitant
- nortriptyline
- oliceridine
- ondansetron
- opium
- oxybate
- oxycodone
- oxymorphone
- ozanimod
- palonosetron
- paroxetine
- pentazocine
- procarbazine
- promethazine
- protriptyline
- rasagiline
- remifentanil
- repotrectinib
- rizatriptan
- ropeginterferon alfa-2b
- safinamide
- SAMe
- selegiline
- sertraline
- St. John's wort
- sufentanil
- sumatriptan
- tapentadol
- thalidomide
- tramadol
- trazodone
- trimethobenzamide
- trimipramine
- venlafaxine
- vilazodone
- vortioxetine
- yohimbe
- ziprasidone
- zolmitriptan
- zuranolone
Monitor/Modify Tx
- abrocitinib
- acalabrutinib
- acetazolamide
- adagrasib
- ado-trastuzumab emtansine
- afatinib
- alprazolam
- alteplase
- amiloride
- anacaulase
- anagrelide
- antithrombin
- apalutamide
- apixaban
- argatroban
- asparaginase
- aspirin
- atazanavir
- avapritinib
- axitinib
- baclofen intrathecal
- bevacizumab
- binimetinib
- bivalirudin
- bosentan
- brexanolone
- bromelain
- bromfenac ophthalmic
- bumetanide
- cabazitaxel
- cabozantinib
- calaspargase
- cangrelor
- caplacizumab
- carfilzomib
- celecoxib
- cenobamate
- chloramphenicol
- chlordiazepoxide
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- cisplatin
- clarithromycin
- clobazam
- clonazepam
- clopidogrel
- clorazepate
- cobicistat
- collagenase clostridium histolyticum
- cyclophosphamide
- dabigatran
- dabrafenib
- dalteparin
- danshen
- daprodustat
- daridorexant
- dasatinib
- deferasirox
- defibrotide
- desflurane
- desmopressin
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- diflunisal
- digoxin
- dimethyl fumarate
- dinutuximab
- diosmin
- dipyridamole
- diroximel fumarate
- droperidol
- efavirenz
- encorafenib
- enzalutamide
- epoprostenol
- eptifibatide
- erlotinib
- esketamine
- eslicarbazepine acetate
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- etodolac
- etravirine
- evening primrose oil
- fenoprofen
- fenugreek
- fluphenazine
- flurbiprofen
- flurbiprofen ophthalmic
- fosphenytoin
- fruquintinib
- furosemide
- gabapentin
- gabapentin enacarbil
- garlic
- gefitinib
- gemtuzumab ozogamicin
- ginkgo
- heparin
- hydrochlorothiazide
- hydrocortisone
- hydroxyzine
- ibrutinib
- ibuprofen
- ibuprofen lysine
- icosapent ethyl
- idelalisib
- ifosfamide
- iloprost inhaled
- imatinib
- indapamide
- indomethacin
- inotersen
- iopamidol
- isoflurane
- itraconazole
- ivosidenib
- ketamine
- ketoconazole
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- krill oil
- lemborexant
- lenvatinib
- levoketoconazole
- lifileucel
- lonafarnib
- lopinavir/ritonavir
- lorazepam
- lorlatinib
- lumacaftor/ivacaftor
- magnesium citrate
- magnesium salicylate
- mannitol
- mavacamten
- meclofenamate
- mefenamic acid
- meloxicam
- methazolamide
- methohexital
- methotrexate
- methyl salicylate topical
- metolazone
- mifepristone
- mitapivat
- mitotane
- modafinil
- monomethyl fumarate
- nabumetone
- nafcillin
- naproxen
- nattokinase
- nelarabine
- nelfinavir
- nepafenac ophthalmic
- niacin (vitamin B3)
- nilotinib
- nintedanib
- nusinersen
- olanzapine
- omega-3-acid
- opicapone
- oxaprozin
- oxazepam
- oxcarbazepine
- oxybutynin
- oxytocin
- pacritinib
- pazopanib
- pegaspargase
- penicillin G
- pentobarbital
- pentosan polysulfate sodium
- pentoxifylline
- perphenazine
- pexidartinib
- phenobarbital
- phenytoin
- piperacillin
- piroxicam
- pirtobrutinib
- plasminogen, human
- polyethylene glycol
- polyethylene glycol/electrolytes
- ponatinib
- porfimer
- posaconazole
- pralsetinib
- prasugrel
- pregabalin
- primidone
- propofol
- quazepam
- ramucirumab
- ranibizumab
- regorafenib
- remimazolam
- reteplase
- ribociclib
- rifabutin
- rifampin
- rifapentine
- ritonavir
- rivaroxaban
- romidepsin
- salsalate
- saquinavir
- saw palmetto
- selinexor
- selpercatinib
- selumetinib
- sevoflurane
- sirolimus albumin-bound
- sorafenib
- sotatercept
- sotorasib
- spironolactone
- sulfate bowel prep
- sulindac
- sunitinib
- suvorexant
- temazepam
- tenecteplase
- thioridazine
- thiothixene
- ticagrelor
- tipranavir
- tirofiban
- tisotumab vedotin
- tivozanib
- tolmetin
- torsemide
- trametinib
- treprostinil
- triamterene
- triazolam
- tucatinib
- upadacitinib
- valproic acid
- vandetanib
- vasopressin
- vinpocetine
- vorapaxar
- voriconazole
- warfarin
- willow bark
- zaleplon
- zanubrutinib
- ziconotide
- ziv-aflibercept
- zolpidem
Caution Advised
- allopurinol
- amantadine
- apomorphine
- apraclonidine ophthalmic
- aprepitant
- aripiprazole
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- asenapine
- baclofen
- berotralstat
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- brompheniramine
- busulfan
- cannabidiol
- cannabis
- carbinoxamine
- cariprazine
- carisoprodol
- cetirizine
- chamomile, German
- chlorambucil
- chlorpheniramine
- chlorzoxazone
- ciprofloxacin
- clemastine
- clofazimine
- clonidine
- clozapine
- conivaptan
- crizotinib
- cyclosporine
- cyproheptadine
- danazol
- dantrolene
- darifenacin
- darunavir
- deutetrabenazine
- dexchlorpheniramine
- dichlorphenamide
- difelikefalin
- difenoxin
- diltiazem
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- domperidone
- dronabinol
- dronedarone
- duvelisib
- entacapone
- entrectinib
- erythromycin
- ethosuximide
- etomidate
- fedratinib
- felbamate
- fesoterodine
- flibanserin
- fluconazole
- fosamprenavir
- ganaxolone
- glofitamab
- glycopyrrolate
- guanfacine
- haloperidol
- hydroxychloroquine
- hyoscyamine
- iloperidone
- isavuconazonium
- lacosamide
- lamotrigine
- lefamulin
- lenacapavir
- letermovir
- levetiracetam
- levocetirizine
- levodopa
- lindane topical
- lofexidine
- loxapine
- lumateperone
- lurasidone
- meclizine
- melatonin
- meprobamate
- methocarbamol
- methsuximide
- methyldopa
- metyrapone
- metyrosine
- molindone
- mosunetuzumab
- mycophenolate mofetil
- naltrexone
- nirogacestat
- orphenadrine
- paliperidone
- passion flower
- perampanel
- pheniramine
- pimozide
- pramipexole
- prochlorperazine
- pyrilamine
- ramelteon
- risperidone
- ropinirole
- rotigotine transdermal
- rufinamide
- scopolamine
- sodium phosphate (bowel prep)
- sodium picosulfate
- solifenacin
- stiripentol
- tasimelteon
- tetrabenazine
- tiagabine
- tizanidine
- tolcapone
- tolterodine
- topiramate
- trifluoperazine
- trihexyphenidyl
- triprolidine
- trospium
- valbenazine
- valerian
- verapamil
- vigabatrin
- viloxazine
- zonisamide
Adverse Reactions .
Serious Reactions
- suicidality
- depression exacerbation
- mania
- serotonin syndrome
- seizures
- bleeding
- hyponatremia
- SIADH
- glaucoma, angle-closure
- withdrawal sx if abrupt D/C
Common Reactions
- diarrhea
- nausea
- headache
- xerostomia
- dizziness
- insomnia
- abdominal pain
- vomiting
- somnolence
- sexual dysfxn
- libido decr.
- fatigue
- flatulence
- erectile dysfxn
- dyspepsia
- restlessness
- abnormal dreams
- appetite incr.
- anorgasmia
- ejaculatory dysfxn
- abdominal distension
- gastroenteritis
- paresthesia
- palpitations
- arthralgia
- weight gain
Safety/Monitoring .
Monitoring Parameters
sx suicidality, clinical worsening, and/or unusual behavior changes, especially during initial tx or after dose changes
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 3rd trimester; inadequate human data available, though risk of neonatal withdrawal sx or serotonin syndrome based on human data w/ SSRIs; risk of neonatal persistent pulmonary HTN or autism inconclusive based on human data w/ SSRIs; no known risk of teratogenicity, though possible risk of decr. fetal wt and delayed skeletal ossification based on animal data at 17x and 48x MRHD; possible risk of maternal postpartum hemorrhage based on human data w/ SSRIs, esp. if used w/in 1mo before delivery
Pregnancy Registry
encourage pts to enroll in National Pregnancy Registry for Antidepressants at 1-844-405-6185 or www.womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver extensively; CYP450: 2C19, 2D6, 3A4 (primary) substrate
Excretion: urine (1% unchanged), feces (2% unchanged); Half-life: 25h
Subclass: Serotonin Modulators
Mechanism of Action
exact mechanism of action unknown; selectively inhibits serotonin reuptake and partially agonizes serotonin 5-HT1A receptors
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Allergan, Inc.
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/viibryd
oral tablet:
- 10 mg (30 ea): $316.00
- 20 mg (30 ea): $316.00
- 40 mg (30 ea): $316.00
oral kit:
- 10 mg, 20 mg (1 dose pack, 30 tablets): $316.00
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