Vilazodone (Viibryd)

Class

SSRI (Selective Serotonin Reuptake Inhibitor) and 5-HT1A receptor partial agonist

Mechanism

Inhibits serotonin reuptake via serotonin transporter (SERT) and acts as a partial agonist at 5-HT1A receptors, potentially enhancing serotonergic neurotransmission with anxiolytic properties.

FDA-Approved Use

Major depressive disorder (MDD)

Off-Label Use

Various anxiety disorders

Formulation

Oral tablets (10 mg, 20 mg, 40 mg)

Titration

10 mg p.o. daily for 7 days, then increase to 20 mg daily, titrating up to 40 mg/day as clinically indicated; must be taken with food for optimal absorption

Dose Range

20–40 mg/day

Kinetics

Half-life ~25 hours; metabolized primarily via CYP3A4; steady state in ~1 week

Common AEs

Diarrhea, nausea, vomiting, dizziness, insomnia, sexual dysfunction

Serious/Rare AEs

Serotonin syndrome, hyponatremia

Monitoring

Monitor for serotonin syndrome and seizure risk in predisposed patients

Black Box Warning

Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders

Considerations

Vilazodone should be used cautiously in patients with a history of seizures, as it may lower the seizure threshold. There is limited evidence for its use in neurodegenerative diseases or other special populations. Reviews of vilazodone’s clinical profile consistently state that, unlike vortioxetine, vilazodone has not demonstrated cognitive-enhancing properties in elderly patients or those with cognitive impairment.