THERAPEUTICS

Brands

• Brintellix

Generic?

• No

Class

• Atypical antidepressant

Commonly Prescribed for

(FDA approved in bold)

• Major depressive disorder

How the Drug Works

• 5-HT1A and 5-HT1B agonist; 5-HT3, 5-HT7, 5-HT1D antagonist; 5-HT transporter inhibitor. May modulate GABAA transmission

How Long Until It Works

• Few weeks to months

If It Works

• Continue to use and monitor for AEs

If It Doesn't Work

• Increase to highest tolerated dose. Switch to other antidepressant

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Polytherapy might be helpful

Tests

• Serum sodium if SIADH (syndrome of inappropriate antidiuretic hormone secretion)

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• By increasing serotonin on non-therapeutic responsive receptors throughout the body. Most AEs are dose- and time-dependent

Notable AEs

• Nausea, constipation, vomiting. Activation of mania/hypomania. Difficulty in sexual desire and performance

Life-Threatening or Dangerous AEs

• Serotonin syndrome

• Angle-closure glaucoma

• SIADH

• Increased risk of bleeding when coadministered with anticoagulants, antiplatelets, or NSAIDs

Weight Gain

• Unusual

Sedation

• Unusual

What to Do About AEs

• For minor AEs, lower dose, titrate more slowly, or switch to another agent. For serious AEs, lower dose and consider stopping, taper to avoid withdrawal symptoms

Best Augmenting Agents to Reduce AEs

• Try magnesium for constipation

DOSING AND USE

Usual Dosage Range

• 10–20 mg/day

Dosage Forms

• Tablet: 5, 10, 15, 20 mg

How to Dose

• Initial dose 10 mg taken daily. Increase to 20 mg if tolerated; 10 mg maximum in known CYP2D6 poor metabolizers

Dosing Tips

• Nausea commonly occurs within the first week. Patients should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior during the initial few months or upon dose changes