Vilazodone (Viibryd)

Primer

Vilazodone (Trade name: Viibryd) is an antidepressant in the serotonin 1A partial agonist and reuptake inhibitor (SPARI) used in the treatment of major depressive disorder.

Pharmacokinetics

See also article: Introduction to Pharmacology

Pharmacokinetics of Vilazodone

Absorption	Take with food! Taking on an empty stomach can result in 50% lower plasma concentrations (and thus and treatment failure)
Distribution
Metabolism
Elimination
Half-life

See also article: Cytochrome (CYP) P450 Metabolism

Vilazodone: Cytochrome P450 Metabolism

Substrate of (Metabolized by)	3A4
Induces
Inhibits

Pharmacodynamics

Mechanism of Action

Similar to vortioxetine, vilazodone acts like an SSRI but also has direct serotonin receptor interactions that is thought to theoretically add to its clinical benefit. It has the following actions:
Serotonin (5-HT) transporter (SERT) inhibition
- Which is the primary mechanism of action of classic antidepressants like SSRIs and SNRIs.
Serotonin (5-HT) receptor partial agonism
- 5-HT1A, which should theoretically leads to enhanced downregulation of presynaptic 5-HT1A receptors and more a robust disinhibition of serotonin release (but this is not clinically proven!), and may make it an anxiolytic as well as antidepressant in action.
Serotonin (5-HT) receptor agonism
- 5-HT4 agonism, which causes diarrhea and is a common side effect of vilazodone.
  - This is why 5-HT4 agonists (e.g. - cisapride, prucalopride) are used in the treatment of constipation

Toxicity

Vilazodone is relatively non-toxic in overdose

Indications

Major depressive disorder

Dosing

Dosing for Vilazodone

Starting
Titration
Maximum
Taper

Formulations

Vilazodone comes in

Monitoring

Contraindications

Absolute

Relative

Drug-Drug Interactions

Side Effects

Adverse Events

Serotonin syndrome

Clinical Pearls

The most recent data suggests there is good tolerability related to weight and sexual side effects as well as anxiety benefits.
Vilazodone has pro-kinetic effects, which can cause diarrhea

Special Populations

Geriatric

See main article: Geriatric Pharmacology

Pediatric

See main article: Pediatric Pharmacology

Obstetric and Fetal

See main article: Obstetric and Fetal Pharmacology

Medically Ill

See main article: Psychotropic Dosing in the Medically Ill

Resources

Slate Star Codex: The Vision Of Vilazodone And Vortioxetine

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