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Tips for tapering vortioxetine / Trintellix / Brintellix

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ADMIN NOTE

Please read this entire topic for tips about tapering vortioxetine.

 

There are many reports on the Web about withdrawal symptoms from vortioxetine, despite their being overlooked by drug companies.

 

Vortioxetine appears to have a withdrawal syndrome similar to almost all the antidepressants and should be tapered slowly to avoid severe or prolonged withdrawal symptoms. See Why taper by 10% of my dosage?

 

According to https://pubchem.ncbi.nlm.nih.gov/compound/vortioxetine#section=Top

 

Quote

Vortioxetine is an atypical antipsychotic and antidepressant indicated for the treatment of major depressive disorder (MDD). It is classified as a serotonin modulator and simulator (SMS) as it has a multimodal mechanism of action towards the serotonin neurotransmitter system whereby it simultaneously modulates one or more serotonin receptors and inhibits the reuptake of serotonin. More specifically, vortioxetine acts via the following biological mechanisms: as a serotonin reuptake inhibitor (SRI) through inhibition of the serotonin transporter, as a partial agonist of the 5-HT1B receptor, an agonist of 5-HT1A, and an antagonist of the 5-HT3, 5-HT1D, and 5-HT7 receptors. SMSs were developed because there are many different subtypes of serotonin receptors, however, not all of these receptors appear to be involved in the antidepressant effects of SRIs. Some serotonin receptors seem to play a relatively neutral or insignificant role in the regulation of mood, but others, such as 5-HT1A autoreceptors and 5-HT7 receptors, appear to play an oppositional role in the efficacy of SRIs in treating depression.

 

According to https://www.drugs.com/pro/brintellix.html , Brintellix is available as 

5mg

10mg

15mg

20mg

 

film-coated tablets. It has a very long half-life, somewhere around 66 hours. There is no ingredient in or coating on the tablet to make it extended-release, that would be unnecessary. (In May 2016, Takeda changed the name of this drug from Brintellix to Trintellix in the US to avoid confusion with another drug.)

 

More biochemical detail about vortioxetine at DrugBank.

 

Vortioxetine is metabolized in the liver by several liver enzymes; however, enzyme cyp 2D6 is very important in its metabolization. Taking vortioxetine with other drugs that are metabolized in the liver, as many psychiatric drugs are, can lead to drug-drug interactions, particularly if the other drugs utilize cyp 2D6.

 

From https://pubchem.ncbi.nlm.nih.gov/compound/vortioxetine#section=Drug-and-Medication-Information

Quote

Vortioxetine has been associated with a low rate of minor serum aminotransferase elevations during treatment, but has not been linked to instances of clinically apparent acute liver injury.

 

Check for drug-drug interactions.

 

Reduce by splitting tablets
Depending on your daily dosage, you may be able to taper by dry-cutting tablets. For example, if you are taking 20mg per day, you may request that your prescription be filled with a combination of 10mg and 5mg tablets with the intention of splitting one 5mg tablet into fourths (1.25mg per quarter tablet). This will enable you to reduce from 20mg to 18.75mg, 17.50mg, 16.25mg, 15mg, 13.75mg, 12.5mg, 10mg -- all reductions within the 10% guideline.

 

(Your doctor will have to specify the reason, such as "take x mg in the a.m. and x mg in the p.m.", for most insurance to cover this type of prescription).

 

At 10mg, you will want to get your prescription filled with two 5mg tablets. At this point, to maintain a reduction rate of 10%, you will need to either 1) use a digital scale to weight tablet fragments of 1mg active ingredient (mgai) or less; OR 2) convert one 5mg tablet into a liquid to measure with an oral syringe. (See below.)

 

Use a digital scale to measure doses

If you are very sensitive to dosage reductions, you may wish to weigh tablet fragments, see Using a digital scale to measure doses

 

Taper with vortioxetine liquid

Measuring a drug for tapering by 10% at a time is easier using a liquid formulation. Since vortioxetine is available in fairly low dosages, you can take part of your daily dosage as a 5mg, 10mg, or 15mg tablet and add the rest as a liquid until your dosage is less than 5mg, where you would take your entire dose as a liquid.

 

Taking part as a tablet and part as a liquid makes it easier to switch from a tablet to a liquid.

 

Vortioxetine liquid may be available by prescription in some countries (other than the U.S). Check with your pharmacist.

 

Make your own vortioxetine liquid

The active ingredient in the tablets, vortioxetine, is slightly soluble in water. This means you or a compounding pharmacy can make a liquid suspension from vortioxetine, see How to make a liquid from tablets or capsules

  • A liquid will be a suspension, not a consistent or "homeogenous" solution. 
  • Vortioxetine is highly soluble in ethanol and a substance called DMSO, as are many psycho-neuro-active prescription medications. Ethanol is readily available in vodka. You can get oral or medical grade DMSO from many sources. If you have questions about this, feel free to post them in this topic.

 

Have a compounding pharmacy make custom capsule dosages or a liquid or for tapering
Compounding pharmacies can make capsules of the drug in any dosage or a liquid from the tablets. You will need a prescription written for the custom compound. The only drawback is this can be expensive.

 


 

I have a friend on vortioxetine (Brintellix) so I was wondering, does anyone have any info on how tapering this drug might look like?

Thanks in advance.

 

Edited by ChessieCat
updated

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

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Lexy

I'm on Brintellix to help get me off effexor. Brintellix has a longer half life than effexor.

Even so I would still taper off at the recommended 10% rate.

When I'm done with effexor I will taper the brintellix. Can I ask how your friend is doing?


Started Effexor August 2012 Sept'12-150mg=extreme anxiety Oct'12 cut half-75mg severe wds

Feb 2013 68.5mg. Mar'13- 65mg. Apr'13-59mg. May'13-57mg. June '13-52mg Aug'13 49.75mg.

Sep'13-48.75. Nov'13-47mg Dec'13-45..5mg

May 2014 42mg. Jun'14 40mg (depressive mood started). Aug'14 -40mg/ started brintellix 2.5mg

Oct '14 -39 Nov'14 36.89 Dec'14 34.45

Jan 2015- 31 Feb'15 29mg. Mar'15 26.72. Apr'15 24.48. May'15 22.31mg. Jun'15 20.30mg

Aug'15-18.89. Oct'15 16.96. Nov/16- 16.10. Dec/15- 15mg

Jan 2016-14.22. May'16 11.45. Aug'16-9.60. Sep/16- 8.88mg. Oct/16- 8.39mg. Nov/16- 8.13. Dec/16- 7.89

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erer

I'm on Brintellix to help get me off effexor. Brintellix has a longer half life than effexor.

Even so I would still taper off at the recommended 10% rate.

When I'm done with effexor I will taper the brintellix. Can I ask how your friend is doing?

She is not doing well - not feeling any effect from the medicine.

 

How are you planning to be doing the 10% cuts for those pills?


  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

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Petunia

Lexy is correct, Brintellix needs to be tapered carefully, starting with the 10% per month method. Its an instant release formula, so using the usual methods here for reducing dose should be appropriate. See:

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/?p=27942


I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal...if you are lucky enough to find one.

My Introduction Thread

Full Drug and Withdrawal History

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety) Xanax PRN ~ Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes

Supplements which have helped: Vitamin C, Magnesium, Taurine

Bad reactions: Many supplements but mostly fish oil and Vitamin D

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

Aug 2016 - Oct 2016 Best window ever, felt almost completely recovered

Oct 2016 -Symptoms returned - bad days and less bad days.

April 2018 - No windows, but significant improvement, it feels like permanent full recovery is close.

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 

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Lexy

Personally I would start with 5-7% taper. You have become sensitized with all the pill switching you have gone through.

I would not want you to destabilize after the all the progress you have made to get to this point.

 

I'm on 3mg brintellix to help with effexor wds. My doctor who believes in withdrawals prescribed B to help buff out wd symptoms.

I will have to taper of that when I'm done with effexor. Please keep updating your taper journey.


Started Effexor August 2012 Sept'12-150mg=extreme anxiety Oct'12 cut half-75mg severe wds

Feb 2013 68.5mg. Mar'13- 65mg. Apr'13-59mg. May'13-57mg. June '13-52mg Aug'13 49.75mg.

Sep'13-48.75. Nov'13-47mg Dec'13-45..5mg

May 2014 42mg. Jun'14 40mg (depressive mood started). Aug'14 -40mg/ started brintellix 2.5mg

Oct '14 -39 Nov'14 36.89 Dec'14 34.45

Jan 2015- 31 Feb'15 29mg. Mar'15 26.72. Apr'15 24.48. May'15 22.31mg. Jun'15 20.30mg

Aug'15-18.89. Oct'15 16.96. Nov/16- 16.10. Dec/15- 15mg

Jan 2016-14.22. May'16 11.45. Aug'16-9.60. Sep/16- 8.88mg. Oct/16- 8.39mg. Nov/16- 8.13. Dec/16- 7.89

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nz11

Just been reading about this trintellix as it is a new word to me and has come to my attention as new people are joining who are taking it.

 

My goodness this drug costs $340 for thirty  5mg tablets.

That's basically $11 a tablet!!!! And that's the price for cash paying customers its apparently different for insurance payers! (no doubt more).

 

Lets say a doctor gets $100 a month prescribing kickback.

Then if he has 100 patients on it then he will get ...wait for it $10,000 a month or $120,000 a year for doing nothing!!!!

Question: If you were a doctor would you like to get more people on trintellix? Would you inform them that once started it may be difficult to get off the drug?

Answer: What do you think!

 

I'd be interested to know what the mg:mg dose equivalent is say with any other ad. Anyone know that?

 

It looks like the pharma marketing department have been doing some overtime thinking up some more nonmedical and non scientific terms ...such as ' serotonin modulator and simulator. '

 

nz11

 

 


Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Jony

Sometimes I get really angry and wonder why these guys are not in jail ...

 

This is the document of approval of the drug by the institute that rules the medicines in Portugal. I didn´t found out in other language, sorry.

 

In the last paragraph of the first page we can read:

 

Interruption of treatment:

Patients treated with Brintellix may stop taking the drug suddenly without the need for a gradual dose reduction (see section 5.1).


Morning

Escitalopram 10 mg from 2005 to present

Dec 10.17 reduced to 9 mg; reinstated 10 mg; Jan 2.18 9 mg; Fev 12.18 8 mg; Jan 30.20 5 mg; Feb 6.20 reinstated 6 mg

Ethyl Loflazepate 2 mg from 2005 to present

 

Night

Mirtazapine 15 mg from 2015 to present (November reinforcement 30mg) Dec 8.17 15 mg

Levomepromazine 25 mg started November 2017

8/12/2017 12.5 mg; 13/12/17 6.25 mg; 20/12/2017 3.125 mg; 23/12/2017 last 3.125 mg

Clonazepam 2 mg started Nov. 2017 (occasionally) ; last week 2 mg; Dec 19.17 1 mg; Dec 21.17 1.5 mg ; Dec 22.17 2 mg; Jan 2.2018 1.9 mg; Jan 7.2018 3mg; Jan 8.18 2mg; Jan 16.18 1.8 mg; Jan 17.18 1.5 mg ; Jan 18.18 1.7 mg; Jan 19.18 1.6 mg; Fev 12.18 1.5 mg; Jan 30.20 0.5 mg

Xanax XR 1 mg in subtitution of Ethyl Loflazepate 2mg (occasionally)

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manny03
On 1/6/2018 at 7:45 AM, Jony said:

Sometimes I get really angry and wonder why these guys are not in jail ...

 

This is the document of approval of the drug by the institute that rules the medicines in Portugal. I didn´t found out in other language, sorry.

 

In the last paragraph of the first page we can read:

 

Interruption of treatment:

Patients treated with Brintellix may stop taking the drug suddenly without the need for a gradual dose reduction (see section 5.1).

I was taking 5mg for two years and followed this advice. Good lord, I'm experiencing some intense withdrawals. I stopped in July 2018. Today, I'm still experiencing weakness, skin rashes/hives, shifting headaches, eye pressure, visual disturbances. I asked the local pharmacist about this, she went back and told me this exact thing. She mentioned the only way this could be happening is due to length of time I took the medication and recommend me to reinstate. 


Trintellix (Brintellix) 5mg - December 2015 to Mid July 2018

Vitamin C 500mgs daily January 2019 - March 30 2019 Boost my immune system through my withdrawal - Stopped

Up and Up 3 Billion Probiotics - Daily for IBS. - Stopped

Up and Up 30 Billion Probiotics - Daily for IBS. - Stopped

 

June 16-26 2018: C/T to take Antiviral medication for Shingles outbreak (Due to excessive stress - SSRI Poop Out). 

June 27 2018: Reinstated (5mg)

July 14 2018 last dose due to acute withdrawal symptoms. 

 

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Pattycat

Has anyone tapered off brintellix yet? 

Im on 2.5 m nightly.im interested in ways to lower my dose safely.

At the moment im cutting a 5mg tablet in half.

Once i cut about 5 tablets in half,and put them all in an old coffee cup in the top cupboard.(sick of cutting them.) 

So onward i go, taking my meds, when i started having withdrawal symptoms. I found that even my disrupting my dose, (cutting 5 or 6 tablets up at once) can have a real effect on me.

So i had to return to cutting them only as i needed them,to ensure that while i may not be getting exactly 2.5 mg per day,but i was definitely getting 5 mg every 2nd day,and my nervous system settled back down.


2005-2012 250 mg pristiq.3 month taper meltdown(dr knows best)

2012-2013 40 mg prozac stopped due to extreme anxiety.

2014-present 20 mg brintellix viortioxetine. Dropped down to 10 mg 5-6 months ago. Overnight (dr knows best) now on 10 mg with bearable withdrawal hoping to ride it out, then taper.

 

Last 2 years 2.5mg brintellix. Hoping to taper off.

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