Vilazodone

About Vilazodone

Vilazodone is thought to work mainly by blocking the reuptake of serotonin in the brain, and it is also a partial agonist at serotonin 5-HT1A receptors. Its label covers major depressive disorder in adults; it is not approved for children or teenagers, and two eight-week studies in patients aged 7 to 17 did not show that it works. Treatment starts at 10 mg once a day with food for 7 days, then 20 mg once a day; the dose can go to 40 mg after at least 7 more days, and the recommended range is 20 to 40 mg once daily. With strong CYP3A4 inhibitors such as clarithromycin, itraconazole or voriconazole the dose is capped at 20 mg, and with strong inducers such as carbamazepine, phenytoin or rifampin taken for more than 14 days the prescriber may raise it, to no more than 80 mg a day.

The boxed warning is that antidepressants raised the risk of suicidal thoughts and behavior in children, teenagers and young adults in short-term studies, so mood and behavior are watched closely, especially early on and after dose changes, and people are screened for bipolar disorder before starting. MAO inhibitors are contraindicated with it and within 14 days of stopping either drug, and it is not started in someone receiving linezolid or intravenous methylene blue. Other warnings cover serotonin syndrome, bleeding (more likely with aspirin, NSAIDs, other antiplatelet drugs, warfarin and other anticoagulants), mania, seizures, angle-closure glaucoma, low sodium and sexual side effects. Diarrhea, nausea, vomiting and trouble sleeping are the most common side effects.

Food matters: the label says that taken without food, the drug may not reach adequate levels and may work less well, so every dose goes with a meal. Stopping is done in steps, from 40 mg to 20 mg for 4 days and then 10 mg for 3 days, or from 20 mg to 10 mg for 7 days, because stopping suddenly can cause dizziness, nausea, headache, irritability, trouble sleeping and tingling in the hands or feet. It raises digoxin levels, so digoxin is measured before vilazodone starts.

Taking Vilazodone

How to take it

Once a day with food, at about the same time each day; on an empty stomach less of it is absorbed. The dose is raised no more than once every 7 days, and it is tapered rather than stopped suddenly.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from heat and moisture (not in the bathroom), out of reach of children. Use a take-back program for unused tablets.

Interactions to know about

MAO inhibitors, including linezolid and methylene blue, must not be combined with it. Triptans, other antidepressants, tryptophan and St. John’s wort add to the risk of serotonin syndrome, and aspirin, ibuprofen, naproxen, warfarin and other blood thinners add to the risk of bleeding. Strong CYP3A4 inhibitors such as clarithromycin and itraconazole raise its levels, carbamazepine, phenytoin and rifampin lower them, and it raises digoxin levels.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Vilazodone differs from pharmacy to pharmacy

Generic vilazodone comes from only a handful of makers, so it is not on every pharmacy’s flat-price list, and quotes for the same tablet vary between pharmacies. Each strength is priced as its own product, and a prescription that names Viibryd and does not allow substitution is quoted at the brand price.

Treatment starts with a week of 10 mg tablets before moving up, so whether the starting dose is written for the exact small quantity needed or for a full bottle changes what the first fill costs.

Ways to pay less for Vilazodone without insurance

• Ask for generic vilazodone, and make sure the prescription allows substitution rather than naming Viibryd only.
• When starting, ask the prescriber to write the 10 mg tablets for just the seven days you need them.
• Once your dose is steady, ask for a ninety-day supply and compare more than one pharmacy.
• If generic vilazodone is still quoted high, ask the prescriber whether an older generic antidepressant would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Vilazodone

1. 1.Does a light snack count as taking my dose with food?
2. 2.How do I step up from 10 mg to my target dose?
3. 3.Could my antibiotics, antifungals or seizure medicines change my dose?
4. 4.Which of my pain relievers or blood thinners raise my bleeding risk with it?

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