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    Trintellix

    Drug - Trintellix® (vortioxetine) [Takeda Pharmaceuticals American, Inc.] formerly Brintellix® (vortioxetine) [Takeda Pharmaceuticals American, Inc.]

    October 2016

    Therapeutic area - Antidepressant

    Approval criteria

    • Patient is 18 years of age or older AND
    • Patient has a diagnosis of major depressive disorder AND
    • Patient has tried and failed two separate 2 month trials of 2 preferred SSRIs AND
    • Patient has a documented intolerance/contraindication to OR has tried and failed a 2 month trial of 1 other preferred new generation antidepressant (i.e. venlafaxine, bupropion, mirtazapine or a tri-cyclic antidepressant).

    Selective Serotonin Reuptake Inhibitors

    Preferred Nonpreferred
    citalopram
    escitalopram    		 Celexa
    fluoxetine Lexapro
    Paxil/Paxil CR
    paroxetine Prozac
    Pexeva Fluoxetine DR (weekly)
    Prozac Weekly
    sertraline paroxetine suspension
    Sarafem
    Viibryd (individual PA criteria apply)
    Zoloft

    New Generation Antidepressants

    Preferred Nonpreferred
    bupropion IR, SA, XL Aplenzin* (bupropion HBr)
    fluvoxamine Cymbalta
    mirtazapine Desyrel
    nefazodone Effexor, Effexor XR
    trazodone Luvox CR*
    venlafaxine extended release Pristiq*
    venlafaxine extend release capsules (generic EffexorXR) Remeron
    venlafaxine extended release tablets (generic) Wellbutrin/SR/XL
    * individual PA criteria apply

    Quantity limits

    • Quantity Limit = 34 (all strengths)

    Background information

    The mechanism of the antidepressant effect of vortioxetine is not fully understood, but is thought to be related to its enhancement of serotonergic activity in the CNS through inhibition of the reuptake of serotonin (5-HT). It also has several other activities including 5-HT3 receptor antagonism and 5-HT1A receptor agonism. The contribution of these activities to vortioxetine’s antidepressant effect has not been established. Recommended starting dose is 10mg once daily and may be increased to a maximum 20mg once daily. There are many other drugs indicated in the initial treatment of MDD including: tricyclic antidepressants (TCAs), SSRIs, SNRIs, bupropion and mirtazapine.

    Rationale

    The most recent guidelines published by Kaiser Permanente Care Management Institute in 2006 for the treatment of depression in primary care recommend SSRIs, TCAs, serotonin norepinephrine reuptake inhibitors SNRIs, and dopamine agonists as first-line treatment of MDD. The preference of antidepressant is based on patient’s history with drug treatment, clinician choice, adverse effects, among other factors. There are no clinical trials comparing the efficacy or safety of vortioxetine to other antidepressants. It is not clear if vortioxetine offers any unique efficacy or safety advantage over existing therapies.

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

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