Vortioxetine, sold under the trade names Trintellix and Brintellix among others, is a medication used to treat major depressive disorder. Effectiveness is viewed as similar to that of other antidepressants. In Britain, it is only recommended in people who have not improved sufficiently on two other antidepressants. It is taken by mouth.
|Trade names||Trintellix, Brintellix, others|
|Other names||Lu AA21004|
|By mouth (film-coated tablets)|
|Bioavailability||75% (peak at 7–11 hours)|
|Metabolism||Extensive Liver, primarily CYP2D6-mediated oxidation|
|Elimination half-life||66 hours|
|Excretion||59% in urine, 26% in feces|
|CompTox Dashboard (EPA)|
|Chemical and physical data|
|Molar mass||298.45 g/mol (379.36 as hydrobromide) g·mol−1|
|3D model (JSmol)|
|(what is this?)|
Common side effects include constipation and nausea. Serious side effects may include suicide in those under the age of 25, serotonin syndrome, bleeding, mania, and SIADH. A withdrawal syndrome may occur if the dose is rapidly decreased. Use during pregnancy and breastfeeding is not generally recommended. It is classified as a serotonin modulator. How it works is not entirely clear but is believed to be related to increasing serotonin levels.
Vortioxetine is used as a treatment for major depressive disorder. Effectiveness appear to be similar to other antidepressants. It may be used when other treatments have failed. A 2017 Cochrane review on Vortioxetine determined that the place for it in the treatment of severe depression is unclear due to low quality evidence and that more study is needed comparing Vortioxetine to SSRIs which are typical first line treatments.
Vortioxetine is also used off label for anxiety. A 2016 review found it was not useful in generalized anxiety disorder at 2.5, 5, and 10 mg doses (15 and 20 mg doses were not tested). A 2019 meta-analysis found that vortioxetine didn't produce statistically significant results over the placebo in the symptoms, quality of life and remission rates of the generalised anxiety disorder, but it was well tolerated.
The most common side effects reported with vortioxetine are nausea, diarrhea, dry mouth, constipation, vomiting, flatulence, dizziness, and sexual dysfunction. However, with the singular exception of nausea, these side effects occurred in less than 10% of study participants given the active drug, with up to 8% of placebo-treated participants reporting the same side effects.
If vortioxetine is prescribed alongside traditional selective serotonin reuptake inhibitors (SSRIs), or other serotonergic drugs, this can induce the potentially life-threatening serotonin syndrome.
Incidence of sexual dysfunction is only slightly higher in patients taking vortioxetine than in people taking placebos and occurs in less than 10% of vortioxetine-treated patients. As such, vortioxetine may be appropriate for people who have suffered sexual side effects from other antidepressant medications.
It increases serotonin concentrations in the brain by inhibiting its reuptake in the synapse, and by modulating (activating certain receptors while blocking, or antagonizing, others) certain serotonin receptors. This puts it in the class of atypical antidepressants known as serotonin modulators and stimulators.
|Ki (nM)||IC50 / EC50 (nM)||IA (%)|
* Human isoforms
Steady-state mean Cmax values were 9, 18, and 33 ng/mL following doses of 5, 10, and 20 mg/day. Steady-state plasma concentrations are typically reached within two weeks.
In 2007, the compound was in Phase II clinical trials, and Lundbeck and Takeda entered into a partnership in which Takeda paid Lundbeck $40 million upfront, with promises of up to $345 million in milestone payments, and Takeda agreed to pay most of the remaining cost of developing the drug. The companies agreed to co-promote the drug in the US and Japan, and that Lundbeck would receive a royalty on all such sales. The deal included another drug candidate, tedatioxetine (Lu AA24530), and could be expanded to include two other Lundbeck compounds.
Society and cultureEdit
Vortioxetine was previously trademarked as Brintellix in the United States, but on May 2, 2016, the US FDA approved a name change to Trintellix in order to avoid confusion with the blood-thinning medication Brilinta (ticagrelor).
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- British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 376. ISBN 9780857113382.
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- Connolly, KR; Thase, ME (2016). "Vortioxetine: a New Treatment for Major Depressive Disorder". Expert Opinion on Pharmacotherapy. 17 (3): 421–31. doi:10.1517/14656566.2016.1133588. PMID 26679430. S2CID 40432194.
The authors suggest that vortioxetine is currently a good second-line antidepressant option and shows promise, pending additional long-term data, to become a first-line antidepressant option.
- Köhler, Stephan; Cierpinsky, Katharina; Kronenberg, Golo; Adli, Mazda (2016). "The serotonergic system in the neurobiology of depression: Relevance for novel antidepressants". Journal of Psychopharmacology. 30 (1): 13–22. doi:10.1177/0269881115609072. PMID 26464458. S2CID 21501578.
- Bobo, William; Kelliny, Marc; Croarkin, Paul; Moore, Katherine (2015). "Profile of vortioxetine in the treatment of major depressive disorder: An overview of the primary and secondary literature". Therapeutics and Clinical Risk Management. 11: 1193–212. doi:10.2147/TCRM.S55313. PMC 4542474. PMID 26316764.
- Koesters, Markus; Ostuzzi, Giovanni; Guaiana, Giuseppe; Breilmann, Johanna; Barbui, Corrado (2017-07-05). "Vortioxetine for depression in adults". The Cochrane Database of Systematic Reviews. 7: CD011520. doi:10.1002/14651858.CD011520.pub2. ISSN 1469-493X. PMC 6483322. PMID 28677828.
- Pae, Chi-Un; Wang, Sheng-Min; Han, Changsu; Lee, Soo-Jung; Patkar, Ashwin A.; Masand, Praksh S.; Serretti, Alessandro (May 2015). "Vortioxetine, a multimodal antidepressant for generalized anxiety disorder: a systematic review and meta-analysis". Journal of Psychiatric Research. 64: 88–98. doi:10.1016/j.jpsychires.2015.02.017. ISSN 1879-1379. PMID 25851751.
- Fu, Jie; Peng, Lilei; Li, Xiaogang (2016-04-19). "The efficacy and safety of multiple doses of vortioxetine for generalized anxiety disorder: a meta-analysis". Neuropsychiatric Disease and Treatment. 12: 951–959. doi:10.2147/NDT.S104050. ISSN 1176-6328. PMC 4844447. PMID 27143896.
- Qin, Bin; Huang, Guangsu; Yang, Qian; Zhao, Mingjun; Chen, Hong; Gao, Wen; Yang, Mingxiu (November 2019). "Vortioxetine treatment for generalised anxiety disorder: a meta-analysis of anxiety, quality of life and safety outcomes". BMJ Open. 9 (11): e033161. doi:10.1136/bmjopen-2019-033161.
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- Daniel Beaulieu for First Word Pharma. September 5th, 2007 Lundbeck, Takeda enter strategic alliance for mood disorder, anxiety drugs Archived 2016-10-10 at the Wayback Machine
- FDA approves new drug to treat major depressive disorder Archived 2013-10-03 at the Wayback Machine, U.S. Food and Drug Administration Press Announcement.
- EMA Brintellix page at EMA site Archived 2016-01-26 at the Wayback Machine Page accessed January 19, 2016
- Commissioner, Office of the. "Safety Alerts for Human Medical Products - Brintellix (vortioxetine): Drug Safety Communication - Brand Name Change to Trintellix, to Avoid Confusion With Antiplatelet Drug Brilinta (ticagrelor)". www.fda.gov. Archived from the original on 2016-05-05. Retrieved 2016-05-02.
- "Vortioxetine". Drug Information Portal. U.S. National Library of Medicine.