vortioxetine

Vortioxetine is an antidepressant approved for the management of major depressive disorder in adults. It is marketed in the United States as Trintellix and in the European Union as Brintellix.

Vortioxetine is described as a multimodal antidepressant because of its combined action on serotonin pathways. It functions as a serotonin transporter (SERT) inhibitor, increasing synaptic serotonin, and modulates several serotonin receptors: it is a partial agonist at 5-HT1A receptors, a partial agonist at 5-HT1B receptors, and an antagonist at 5-HT3 and 5-HT7 receptors, with weaker activity at other serotonergic targets.

It is indicated for major depressive disorder in adults and is not approved for children or adolescents. The medication is taken by mouth once daily. Typical starting doses are 5 mg, with titration to 10 or 20 mg daily based on response and tolerability, with a maximum recommended dose of 20 mg.

Common adverse effects include nausea, headache, dizziness, and constipation. Sexual dysfunction tends to be less frequent than with some other antidepressants. Other considerations include a potential risk of hyponatremia in older adults and a risk of serotonin syndrome when used with other serotonergic agents. Discontinuation should be gradual to reduce withdrawal symptoms.

Pharmacokinetically, vortioxetine is absorbed orally and metabolized in the liver, principally by CYP2D6, with contributions from CYP3A4, CYP2C9, and CYP2C19. It has a relatively long elimination half-life, supporting once-daily dosing. Pregnancy and breastfeeding should be discussed with a clinician, given potential risks.