Drug - Trintellix® (vortioxetine) [Takeda Pharmaceuticals American, Inc.] formerly Brintellix® (vortioxetine) [Takeda Pharmaceuticals American, Inc.]
October 2016
Therapeutic area - 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 |
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.
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.
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