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‹< Brintellix’s Pharmacology |

US brand name: Brintellix
Generic name: vortioxetine

Comments

Brintellix is the new and shiny AD with a severe identity crisis. Is it basically an SSRI or SNRI? Is it part triptan or part antipsychotic? Is it a floor wax or desert topping?

In answer to the first question, I think its basic mechanism of action (MOA) is being as much of an SNRI as Effexor is, but since the maximum recommended dosage tops off at 20 mg, and 30 mg a day seems to be the maximum tolerable dosage1, it might work as an SNRI at 20 mg day. I’m pretty sure it would at 25 mg a day. One of the key indicators of too much norepinephrine are physical and psychological symptoms of anxiety, and many people have complained about Brintellix making their anxiety worse. That’s an all-too-common side effect when an SNRI is prescribed for anxiety, with or without depression. But as all the research done has focused on its serotonergic effects, and all of its bonus material involves serotonin receptors, few people will consider vortioxetine’s primary mechanism of action to be anything but serotonergic. So I’m seeing it called an SSRI even though it isn’t an SSRI. Viibryd isn’t technically an SSRI, but even I’ll call it one, because Viibryd’s MOA is pretty much the equivalent of taking a cocktail of Paxil and BuSpar. Brintellix does way too much to be called an SSRI, so people are going to be surprised, in good ways and bad, by thinking of it as one.

I’m being facetious when I’m comparing triptans with antipsychotics. Triptans are 5HT1B and 5HT1D agonists. Vortioxetine is a 5HT1B partial agonist and 5HT1D antagonist. Along with all the other stuff it does that makes Brintellix like one of the oddest APs around.

And it’s both a floor wax and a desert topping. Duh.

One thing I’ve noticed is how few people are using this med. On one hand it’s nice to see doctors not jumping on something new and shiny just because it’s new and shiny, on the other Brintellix has a lot of potential. Sure, it’s not as effective as Cymbalta, but for a highly-targeted serotonergic med, with just a little norepinephrine action on the side, it might be just the thing for some people. As with too many drugs I’ve noticed the usual story: inappropriate prescribing. A lot of people for whom Brintellix did not work due to intolerable side effects were taking 20mg a day and Wellbutrin - didn’t their dipshit doctors or pharmacists read the PI sheets? That’s the equivalent of 40 mg a day! Unless you’ve had a gene test showing you have at least half-a-dozen copies of the CYP2D6 gene2, 30 mg is the highest you should go. Or they were also taking a high dosage of a CYP2D6-inhibiting SSRI (Paxil or Prozac) and got serotonin syndrome! Well, duh. What sort of quacks are doing the prescribing? Don’t those morons know it’s not approved as a fucking add-on? If they want to exploit its more-than-an-SSRI effects they should be prescribing 5 mg, not 15 to 20 mg. The R&D people at Takeda and Lundbeck bent over backwards to provide some of the most complete information possible about a med I’ve seen when it first came out - I’m really sorry I didn’t write about it sooner - and idiot doctors are ruining it by prescribing it at 20 mg a day with meds where, on the very first page of the PI sheet it says to cut the dosage in half! It also looks as if some poor CYP2D6 metabolizers are being prescribed too much. Intermediate metabolizers probably shouldn’t go above 15 mg a day, so a lot of them are being screwed by rigid thinking and target dosages.

One thing’s for sure, Brintellix should not be the first serotonergic med you try. If you’re taking an SSRI or SNRI now and it more-or-less works, but also caused one or more of:

  • “brain fog” (fuzzy thinking, feeling mentally tired but not physically tired) and/or other cognitive issues
  • messing with your sleep,
  • a lot of weight gain
  • ruining your love life

then you and your doctor might want to discuss Brintellix. Especially if your problem was the brain fog. But if you’re looking for your first AD, stick with Celexa, Lexapro, or Wellbutrin. Unless you know your doctor is a genius psychopharmacologist Brintellix’s long-ass half-life makes it one of the worst meds to try first.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? No

Shapes & Sizes (How Supplied)

  • 5 mg pink tablets
  • 10 mg yellow tablets
  • 15 mg orange tablets
  • 20 mg red tablets

Tablets have the dosage on one side and TL (for Takeda and Lundbeck, I guess) on the other.



Other Trade Names and Overseas Availability

Not including controlled/extended/sustained release suffixes (Efexor ER, Trevilor retard e.g.) or branded generics that are a hyphenate of the generic name and the drug company name (Apo-Citalopram e.g.).

Available as Brintellix in:

  • Australia
  • Great Britain
  • The EU (but not Ireland)
  • Japan

Overseas Trade Names

  • Trintellix - Canada

Pending approval in:

  • Ireland
  • New Zealand

Alternate INNs (because one isn’t good enough)

  • vortioxetina - Spanish
  • vortioxétine - French
  • vortioxetinum - Latin

Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Brintellix’s Full US Prescribing Information / PI Sheet

Prescribing Information & Patient Information from Around the World

Other Sites of Interest

Consumer Review Sites



Discussion board

If you have any questions not answered here, please see the Crazymeds Brintellix discussion board.

References

  1. Brintellix Full US Prescribing Information
  2. Brintellix EU EPAR
  3. Boulenger, Jean-Philippe, Henrik Loft, and Christina Kurre Olsen. “Efficacy and safety of vortioxetine (Lu AA21004), 15 and 20 mg/day: a randomized, double-blind, placebo-controlled, duloxetine-referenced study in the acute treatment of adult patients with major depressive disorder.” International Clinical Psychopharmacology 29.3 (2014): 138. Published online 4 April 2014
  4. Montgomery, Stuart A., Rebecca Z. Nielsen, Lis H. Poulsen, and Lars Häggström. “A randomised, double‐blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin–noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine.” Human Psychopharmacology: Clinical and Experimental 29, no. 5 (2014): 470-482. Published online: 3 August 2014
  5. Katona, Cornelius L., and Cara P. Katona. “New generation multi-modal antidepressants: focus on vortioxetine for major depressive disorder.” Neuropsychiatric Disease and Treatment 10 (2014): 349.
  6. Sanchez, Connie, Karen E. Asin, and Francesc Artigas. “Vortioxetine, a novel antidepressant with multimodal activity: Review of preclinical and clinical data.” Pharmacology & Therapeutics (2014).
  7. McIntyre, Roger S., Søren Lophaven, and Christina K. Olsen. “A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults.” The International Journal of Neuropsychopharmacology (2014): 1-11.
  8. Mørk, A., Alan Pehrson, Lise Tottrup Brennum, S. Møller Nielsen, Huailing Zhong, Anders B. Lassen, Silke Miller et al. “Pharmacological effects of Lu AA21004: a novel multimodal compound for the treatment of major depressive disorder.” Journal of Pharmacology and Experimental Therapeutics 340, no. 3 (2012): 666-675. Published online 9 December 2011
  9. Alvarez, Enric, Victor Perez, and Francesc Artigas. “Pharmacology and clinical potential of vortioxetine in the treatment of major depressive disorder.” Neuropsychiatric Disease and Treatment 10 (2014): 1297.
  10. Bétry, Cécile, Alan L. Pehrson, Adeline Etiévant, Bjarke Ebert, Connie Sánchez, and Nasser Haddjeri. “The rapid recovery of 5-HT cell firing induced by the antidepressant vortioxetine involves 5-HT3 receptor antagonism.” The International Journal of Neuropsychopharmacology 16, no. 05 (2013): 1115-1127.
  11. Chen, Grace, Ronald Lee, Astrid-Maria Højer, Jeppe Klint Buchbjerg, Michael Serenko, and Zhen Zhao. “Pharmacokinetic drug interactions involving vortioxetine (Lu AA21004), a multimodal antidepressant.” Clinical Drug Investigation 33, no. 10 (2013): 727-736. Published online: 23 August 2013
  12. Adell, Albert. “Lu-AA21004, a multimodal serotonergic agent, for the potential treatment of depression and anxiety.” IDrugs: the investigational drugs journal 13.12 (2010): 900-910.
  13. Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761

‹< Brintellix’s Pharmacology |

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1 Again, unless you're like me and your stomach hasn't met a med it didn't like. And you take it with meals. And you aren't mixing it with anything that is also harsh on your GI system.

2 I don't know how many extra copies of the CYP2D6 gene rapid metabolizers tend to have. If you need to take Paxil CR twice a day or you start to get discontinuation symptoms, you probably have a few extra ones. Around 1-2% of the Caucasian population does.


Last modified on Wed, 04 May, 2016 at 16:42:05 by JerodPoorePage Author Date created Thursday, 02 October 2014 at 15:17:50
“Brintellix (vortioxetine): Availability, Comments, Links, More” by Jerod Poore is copyright © 2014 Jerod Poore Published online 2014/10/02

Brintellix, and all other drug names on this page and used throughout the site, are the trademarks of someone else. Brintellix’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.



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Don’t automatically believe everything you read on teh Intergoogles. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. For more details see the Crazymeds big-ass disclaimer.

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