Trintellix dosage, forms, and strengths

Trintellix (formerly sold as Brintellix) is a brand-name prescription drug used to treat major depressive disorder (MDD) in adults. Although vortioxetine, the active ingredient in Trintellix, is classified as an atypical antidepressant, its mechanism of action is similar to selective serotonin reuptake inhibitors (SSRIs) in that it causes serotonin, a neurotransmitter, to persist longer in the brain. Healthcare professionals also believe vortioxetine affects other neurotransmitters as well. No matter what it specifically does to the brain, Trintellix’s overall effects on brain chemistry help to restore mood control and improve cognitive function in people taking the medication. Trintellix is taken once per day as a tablet with or without food.

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Trintellix forms and strengths

Trintellix is taken as a tablet and is available in three dosage strengths:

• Tablets: 5 milligrams (mg), 10 mg, 20 mg

Trintellix dosage for adults

Currently, the U.S. Food and Drug Administration (FDA) has approved Trintellix only for the treatment of major depressive disorder in adults. Trintellix may sometimes be prescribed for off-label uses, such as the treatment of anxiety. Trintellix is contraindicated in anyone allergic to vortioxetine or any of the inactive ingredients in Trintellix. It is also contraindicated in people who have taken a medication known as a monoamine oxidase inhibitor (MAOI) within the past few weeks. Dose adjustments are only necessary for people who are born with a reduced ability to metabolize vortioxetine.

Source: Epocrates

Trintellix dosage for major depressive disorder (MDD)

Trintellix is an atypical antidepressant used to treat adults diagnosed with major depressive disorder or MDD. For depression to qualify as major depressive disorder, symptoms of depression—which may include depressed mood, feeling worthless, loss of enjoyment, loss of interest, low energy, suicidal thoughts, and other symptoms—must persist for two weeks or longer. The active ingredient in Trintellix, vortioxetine, is both a selective serotonin reuptake inhibitor (SSRI) and a serotonin receptor modulator. Serotonin is a neurotransmitter that passes signals between nerves. Vortioxetine may affect other neurotransmitters as well. 

After a few weeks of daily dosing, most people with major depressive disorder will notice improvements in their symptoms. Patients will be started on 10 mg per day, but the dose may be reduced to 5 mg per day if side effects are too hard to take. Although the standard dosage is 20 mg taken once per day, a healthcare provider may prescribe anywhere from a 5 mg daily dose to a 20 mg daily dose.

• Standard dosage for major depressive disorder: 20 mg taken once daily 

• Maximum dosage for major depressive disorder: 20 mg per day

Trintellix dosage for children

Trintellix is not used in children. The safety and effectiveness of Trintellix in children have not been established in placebo-controlled clinical trials.

Trintellix dosage restrictions

Doses are only adjusted for people who are born with a decreased ability to break down vortioxetine. The liver breaks down vortioxetine using an enzyme called CYP2D6. Some people are genetically poor CYP2D6 metabolizers, so vortioxetine will build up in their bloodstream, increasing the risk and severity of side effects. The maximum dose for poor metabolizers is 10 mg per day.

People with renal impairment (kidney dysfunction) or hepatic impairment (liver problems) do not need dose adjustments.

How to take Trintellix

Trintellix is taken once per day every day. Food does not affect the body’s ability to absorb vortioxetine, so Trintellix can be taken with a meal or on an empty stomach.

• Take Trintellix as directed by a healthcare provider. The dose of Trintellix may need to be changed more than once to find the best dose. Do not change the dose unless the doctor tells you to do so. 

• Trintellix comes with a medication guide. It’s a good idea to review this guide, which contains important information about side effects and warnings, every time your Trintellix prescription is refilled.

• Take Trintellix once per day at the same time each day.

• Store Trintellix in a closed container at room temperature (68°F to 77°F) and keep securely out of the reach of children and pets.

Trintellix dosage FAQs

How long does it take Trintellix to work?

Trintellix needs to be taken daily for several weeks before any noticeable improvement in symptoms. 

How long does Trintellix stay in your system?

The terminal half-life of Trintellix is 66 hours, or about three days. Terminal half-life measures how long the body takes to eliminate half a dose of a drug from the body and it usually takes five or six half-lives for the body to completely eliminate a drug. For Trintellix, this means it will take about two weeks to clear the last dose of Trintellix from the body. 

What happens if I miss a dose of Trintellix?

If a dose is accidentally missed, it’s okay to take it as soon as it’s remembered. However, skip the missed dose if it’s almost time for the next dose. Do not take a higher dose to make up for a missed dose.

Missing doses can reduce the benefits of Trintellix treatment. Consider using an alarm, cell phone app, pillbox, or alarm pill cap to help you to remember to take each day’s dose.

How long can you take Trintellix?

Trintellix is intended for long-term treatment. There are no known problems associated with the long-term use of vortioxetine.

It usually takes four to six weeks of antidepressant treatment to relieve depression symptoms. However, even if a person feels much better after six weeks of treatment, it’s important to keep taking Trintellix. There is a risk that depression symptoms will return if the medication is stopped. Healthcare providers, then, typically prescribe antidepressants for at least six to nine months of continuous daily dosing to prevent a recurrence of depression. Severe depression may require taking Trintellix every day for a year or more. Some patients take antidepressants for many years.

How do I stop taking Trintellix?

Do not stop taking Trintellix except under the medical advice of a healthcare professional. Sudden discontinuation of Trintellix can produce a type of withdrawal called antidepressant discontinuation syndrome. Symptoms include nausea, dizziness, sweating, anxiety, agitation, irritability, mood swings, tremor, sleeplessness, confusion, an electric shock feeling, seizures, and headache. To prevent withdrawal, the prescribing healthcare professional will use a steadily decreasing dose to wean the patient off the drug.

There are reasons to stop Trintellix treatment. In some cases, the drug may not work. Or there may be serious side effects such as allergic reactions, worsening depression, angle-closure glaucoma, low blood sodium, bleeding problems, or mania or hypomania in someone as yet undiagnosed with bipolar disorder. There is also a black box warning, the strongest warning required by the FDA. Antidepressants, including Trintellix, can cause people to have suicidal thoughts and behavior. Although this occurs more in young adults, anyone who is taking Trintellix should be aware of mental or mood changes, and report any changes to the doctor. Loved ones and caregivers should also be alert to any changes in behavior or mood. Trintellix is not approved for use in people under 18 years old.

Some people may want to stop taking Trintellix because they’re unhappy with less serious side effects such as sexual dysfunction, dry mouth, abnormal dreams, weight gain, or constipation. 

There are many alternative antidepressants for people who want or need to stop treatment with Trintellix. These include a wide range of selective serotonin reuptake inhibitors (SSRIs) including Prozac (fluoxetine) or Lexapro (escitalopram), serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine), tricyclic antidepressants, and other atypical antidepressants. 

What is the maximum dosage for Trintellix?

The maximum dose of Trintellix is 20 mg per day.

Can you overdose on Trintellix?

An overdose of Trintellix (up to 75 mg) can result in symptoms such as nausea, dizziness, diarrhea, abdominal pain, itching, flushing, and sleepiness. If an overdose is suspected, call a poison control center or seek medical help.

A serious overdose could cause serotonin syndrome, a life-threatening condition due to the buildup of serotonin. Serotonin syndrome can occur after an overdose, or when several drugs that increase serotonin are taken together. Symptoms of serotonin syndrome include agitation, sweating, fever, confusion, changes in blood pressure, hallucinations, dizziness, shaking, muscle tension, nausea, vomiting, and diarrhea. Serotonin syndrome is a serious medical condition and requires emergency medical attention if any symptoms are noticed.

What interacts with Trintellix?

Trintellix has several drug interactions that can cause a variety of adverse effects. First off, Trintellix should never be taken with monoamine oxidase inhibitors (MAOIs), a small family of medications that includes certain antidepressant drugs (phenelzine, isocarboxazid, tranylcypromine), the antibiotic linezolid, certain Parkinson’s disease medications (rasagiline and selegiline), and a common medical imaging contrast dye (methylene blue injection). Trintellix can be started at least 14 days after the MAOI is stopped.

Trintellix is a serotonergic drug, that is, it raises the amount of serotonin in the brain. Serotonin transmits signals between nerves, so too much serotonin can cause overexcitement in the brain, a condition called serotonin syndrome. Though serotonin syndrome is rare, the most common way it occurs is when two or more serotonergic drugs are taken at the same time. A surprisingly large variety of drugs raise serotonin in the brain. The most obvious are other antidepressants. However, many other drugs also increase serotonin levels in the brain: 

• Anxiety medications like buspirone

• Antipsychotics

• Triptans (migraine medications)

• Bipolar mood stabilizers such as lithium

• Opioid pain medicines such as tramadol or fentanyl

• Anticonvulsants/seizure medications such as carbamazepine

• Amphetamines

• Certain anti-nausea drugscertain Parkinson’s disease medications

• Cough medication dextromethorphan which is found in many cough and cold medications

• Some over-the-counter supplements like St. John’s wort and tryptophan.

Aside from serotonin syndrome, other drug combinations can worsen Trintellix side effects because:

• Trintellix increases the risk of bleeding. Do not take Trintellix with other drugs that also interfere with blood clotting, including nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners such as warfarin. 

• Trintellix can lower sodium levels in the body, so combining Trintellix with drugs that also lower sodium such as diuretics puts people at an increased risk for low sodium (hyponatremia). 

• Some drugs interfere with the body’s ability to break down vortioxetine, increasing the risk for adverse reactions. These include well-known antidepressant medications such as Wellbutrin (bupropion), Paxil (paroxetine), or Prozac (fluoxetine) as well as the heart rhythm drug quinidine and other types of drugs. Healthcare professionals will be familiar with all these drugs and will either switch to an alternative or reduce the Trintellix dosage.

• Finally, some drugs increase the speed with which the body breaks down vortioxetine. Called CYP inducers, these drugs stimulate the body to rapidly clear Trintellix from the body, decreasing its effectiveness in treating depression. Strong CYP inducers such as rifampin, carbamazepine, or phenytoin may require Trintellix doses to be increased.

What happens when you mix Trintellix and alcohol?

A single-dose clinical study showed no evidence of increased impairment or other side effects when alcohol is combined with vortioxetine. Still, healthcare professionals believe it’s best to avoid drinking alcohol while taking Trintellix. Patients taking Trintellix should also avoid driving until they know how Trintellix affects them. 

Is it safe to take Trintellix during pregnancy?

Taking antidepressants during pregnancy can be a tough call for women and their prescribing healthcare provider to make. While there are risks to the baby, particularly late in the pregnancy, there’s a risk that depression will relapse if antidepressants are discontinued. Trintellix is no different. Healthcare professionals are cautious about its use, but untreated depression is also risky for both the mother and baby. However, Trintellix, like all other antidepressants, is especially risky when taken during the third trimester. A baby can be born with antidepressant withdrawal symptoms, serotonin syndrome, or other problems when Trintellix is taken too late in pregnancy. Women who are pregnant or planning to become pregnant should consult their doctor before taking Trintellix. 

Although vortioxetine levels in human breast milk are low and no adverse effects to the infant have been recorded, it is not known for certain if breastfeeding is safe when Trintellix is being taken. Breastfeeding mothers should consult their doctor about antidepressant use.

Related resources for Trintellix dosages:

• Antidepressant discontinuation syndrome, American Family Physician

• Trintellix, Epocrates

• Trintellix prescribing information, U.S. National Library of Medicine

• Vortioxetine: Clinical pharmacokinetics and drug interactions, Clinical Pharmacokinetics

• Vortioxetine drug summary, Prescriber’s Digital Reference

• Vortioxetine, Drugs and Lactation Database

• Vortioxetine (Trintellix). National Alliance on Mental Illness (NAMI)