Viibryd dosage, forms, and strengths

Viibryd is a brand-name prescription drug used to treat major depressive disorder in adults. Vilazodone hydrochloride, the active ingredient in Viibryd, belongs to a family of drugs called atypical antidepressants. However, it works similarly to selective serotonin reuptake inhibitors (SSRIs) by blocking the brain’s reuptake of serotonin, a chemical that passes signals between nerves and regulates mood. However, in addition to its effects on serotonin reuptake, vilazodone also mimics serotonin in the brain. Through both of these mechanisms, Viibryd gives patients better control over their mood.

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Viibryd forms and strengths

Viibryd is an oral medicine taken as a tablet in one of three dosage strengths.

• Tablets: 10 mg, 20 mg, 40 mg

For people starting Viibryd treatment, all three dosage strengths are packaged together in the Viibryd starter pack containing seven days of 10 mg tablets, seven days of 20 mg tablets, and 16 days of 40 mg tablets.

Viibryd dosage for adults

Viibryd is FDA-approved to treat major depressive disorder in adults. It is taken as a tablet by mouth once per day with food.

Source: Epocrates

Viibryd dosage for major depressive disorder

Viibryd is an atypical antidepressant used for the treatment of major depressive disorder in adults. A diagnosis of major depressive disorder requires that at least five specific depression symptoms are present for two weeks or longer with at least one symptom including depressed mood or loss of interest. These symptoms must affect quality of life and cannot be caused by a substance.

Although vilazodone, the active ingredient in Viibryd, is classified as an atypical antidepressant, it works similarly to commonly prescribed SSRIs such as Prozac (fluoxetine) and Paxil (paroxetine) by blocking serotonin reuptake in the brain. By increasing serotonin in the parts of the brain responsible for mood regulation, Viibryd gives patients better control over their mood. However, in addition to its SSRI activity, vilazodone also acts as a partial serotonin agonist, activating one of the serotonin receptors, 5-HT1A, just as serotonin does. Because of this dual mechanism of action, vilazodone is classified as a serotonin partial agonist reuptake inhibitor (SPARI). 

Most patients will start on 10 mg of Viibryd per day for the first seven days. The dose is recommended to be increased to 20 mg per day for the next seven days. Depending on side effects or how well the drug works, the dose may either stay at 20 mg per day or be increased to 40 mg per day.

• Standard adult dosage for major depressive disorder: 20–40 mg taken once daily 

• Maximum adult dosage for major depressive disorder: 40 mg per day

Viibryd dosage for children

Healthcare professionals do not know if Viibryd is either safe or effective in children. For this reason, Viibryd is not approved for use in pediatric patients. 

Viibryd dosage restrictions

Viibryd has no dosage restrictions. The only contraindications are allergies to vilazodone or any of the inactive ingredients in the Viibryd tablet. However, some people taking Viibryd may require close monitoring for adverse effects, such as elderly patients, people with bipolar disorder, low blood sodium (hyponatremia), volume depletion, or seizure disorder, and those who are at risk of bleeding or angle-closure glaucoma. 

Viibryd does have a black box warning about suicide and worsening depression. Like other antidepressants, Viibryd has the potential to worsen depression and provoke suicidality in young adults. Healthcare providers should closely monitor young patients for suicidal thoughts, suicidal behaviors, or any unusual changes in behavior.

How to take Viibryd

Viibryd is taken by mouth as a tablet once per day with food.

• Take Viibryd as directed by a healthcare professional. Do not change the dose or stop taking Viibryd without consulting with the prescribing healthcare provider.

• Viibryd is packaged with a medication guide. This guide contains important information about how to take Viibryd, possible side effects, and what to do if there are problems. Please read this guide before taking this medicine.

• Take Viibryd once per day with food.

• Swallow the Viibryd tablet whole with a glass of water.

• Store Viibryd in a closed container at room temperature (59°F to 77°F) out of the reach of children

Viibryd dosage FAQs

How long does it take Viibryd to work?

Viibryd may not show improvements in depression symptoms for several weeks. Continue to take daily doses even if it takes a while for symptoms to improve.

How long does Viibryd stay in your system?

Vilazodone has a terminal half-life of 25 hours, so it should take about five days for the body to completely eliminate a dose of Viibryd.

What happens if I miss a dose of Viibryd?

Take a missed dose as soon as it’s remembered. If it’s almost time for the next dose, then skip the missed dose and take the next regular dose as scheduled. Do not take two doses to make up for a missed dose.

It’s important not to miss doses when taking antidepressants. If there’s a problem remembering to take Viibryd doses, ask a pharmacist for tools that can help, such as alarms, cell phone apps, daily pillboxes, or pill bottle caps with built-in alarms. 

How long can you take Viibryd?

As with other antidepressants, Viibryd is intended for long-term treatment lasting several months or more. It usually takes four to six weeks of pharmacologic treatment to relieve depression symptoms and another six to nine months of continuous daily dosing to prevent a recurrence of symptoms. Antidepressant treatment may go on longer for severe or treatment-resistant depression. 

How do I stop taking Viibryd?

Do not stop taking Viibryd unless advised by a healthcare professional. Sudden discontinuation of Viibryd can produce antidepressant discontinuation syndrome, a type of withdrawal characterized by symptoms such as nausea, sweating, irritability, anxiety, agitation, dizziness, tremor, headache, lethargy, mood swings, trouble sleeping, ringing in the ears, weird sensations, and seizures. To prevent antidepressant discontinuation syndrome, the prescribing healthcare professional should steadily decrease the dose to wean the patient off of the drug. It will typically take seven days to taper Viibryd to discontinuation.

Many people will need to stop taking Viibryd before treatment is finished. For some, the drug may not work. Others may need to immediately stop taking the drug because of serious side effects such as allergic reactions, worsening depression, suicidal thoughts (in young adult patients), angle-closure glaucoma, low blood sodium (hyponatremia), bleeding problems, or mania or hypomania in someone with bipolar disorder. Even common side effects might be too difficult to continue taking Viibryd, including erectile dysfunction, sexual impairment, dry mouth, abnormal dreams, or constipation.

Fortunately, healthcare providers can prescribe a wide variety of antidepressants if Viibryd can’t be taken. These include SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and a variety of other atypical antidepressants. 

What is the maximum dosage for Viibryd?

The maximum dose of Viibryd is 40 mg per day.

Can you overdose on Viibryd?

If too much Viibryd is taken, call a poison helpline or get emergency medical help. In clinical trials, taking five to seven times the recommended dose produced symptoms of serotonin syndrome, such as lethargy, restlessness, hallucinations, and disorientation. Other symptoms of serotonin syndrome include agitation, sweating, fever, changes in blood pressure, dizziness, shaking, muscle tension, nausea, vomiting, and diarrhea. Serotonin syndrome is a serious medical issue that requires emergency medical treatment.

What interacts with Viibryd?

Because of possible drug interactions, the healthcare provider prescribing Viibryd needs to know about all the prescription drugs, over-the-counter medications, and supplements being taken, particularly:

• Monoamine oxidase inhibitors (MAOIs) such as linezolid and methylene blue injections. Because of the risk for serotonin syndrome, these drugs must be stopped for at least 14 days before Viibryd can be taken safely. 

• Drugs that treat psychiatric disorders or other serotonergic drugs (drugs that raise serotonin levels) including SSRIs, SNRIs, antidepressants, anxiety medications such as buspirone or antipsychotics, migraine medications such as triptans, bipolar mood stabilizers such as lithium, opioids such as tramadol, seizure medications such as carbamazepine, amphetamines, anti-nausea drugs, Parkinson’s disease medications, and some over-the-counter supplements such as St. John’s wort and tryptophan. Concomitant use of these drugs with Viibryd increases the risk for serotonin syndrome.

• Drugs that interfere with blood clotting, including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin-containing medications, and anticoagulants such as warfarin. Vilazodone also interferes with blood clotting, so there is an increased risk of bleeding when these drugs are taken with Viibryd.

• Drugs that could cause low sodium (hyponatremia) such as diuretics and sulfonylureas. Low sodium is a possible side effect of Viibryd, so the risk of hyponatremia increases when Viibryd is taken with any of these drugs.

In addition, many drugs affect the body’s ability to metabolize vilazodone through the CYP3A4 pathway in the liver. These drugs can either reduce the effectiveness of Viibryd (CYP3A4 inducers) or increase the risk and severity of its side effects (CYP3A4 inhibitors).  Since these drug interactions are not commonly known to most people, it is important to make sure that the prescribing healthcare provider knows about all drugs and supplements being taken. Dosages may need to be adjusted when Viibryd is taken with any drug that affects vilazodone metabolism.

What happens when you mix Viibryd and alcohol?

Avoid drinking alcohol when taking Viibryd. The combination will increase mental impairment caused by both Viibryd and alcohol.  

Is it safe to take Viibryd during pregnancy?

Viibryd is prescribed cautiously in pregnant women. There are no studies on whether or not Viibryd is safe to take during pregnancy. Like other antidepressants, Viibryd may be most risky when taken during the third trimester. A baby can be born with antidepressant withdrawal symptoms, persistent pulmonary hypertension of the newborn (PPHN), or other problems requiring hospitalization or respiratory support if SSRIs are taken in the last trimester. Women who are pregnant or trying to get pregnant will need to consult a healthcare professional about the benefits and risks of taking antidepressants like Viibryd.

Because healthcare providers do not know if vilazodone is safe when taken by breastfeeding mothers, women may be switched to another antidepressant or asked to stop breastfeeding. 

Resources:

• Antidepressant discontinuation syndrome, American Family Physician

• Steps following attainment of remission: discontinuation of antidepressant therapy, Primary Care Companion to The Journal of Clinical Psychiatry 

• Viibryd, Epocrates

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

• Viibryd, AbbVie

• Vilazodone, StatPearls