Gus Alva, MD
Medical Director, ATP Clinical Research
Costa Mesa, CA
Important Safety Information
Indications and Usage
VIIBRYD® (vilazodone HCl) is indicated for the treatment of major depressive disorder (MDD) in adults.
Important Safety Information
WARNING: SUICIDALITY AND ANTIDEPRESSANT DRUGS
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in
short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of VIIBRYD or any other
antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in
the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared
to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of
suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening,
suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the
prescriber. VIIBRYD is not approved for use in pediatric patients.
Warnings and Precautions
- VIIBRYD must not be used concomitantly in patients taking MAOIs or in patients who have taken MAOIs within the preceding 14 days due to the
risk of serious, sometimes fatal, drug interactions with serotonergic drugs. Allow at least 14 days after stopping VIIBRYD before starting an
- All patients treated with antidepressants should be monitored appropriately and observed closely for clinical worsening, suicidality,
and unusual changes in behavior, especially during the first few months of treatment and when changing the dose. Consider changing the
therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or includes symptoms of
anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, mania, or suicidality
that are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Families and caregivers of patients being
treated with antidepressants should be alerted about the need to monitor patients daily. Prescriptions for VIIBRYD should be written for
the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.
- The development of potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions has been reported
with antidepressants alone, but particularly with concomitant use of serotonergic drugs (including triptans) with drugs which impair metabolism of
serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists. Symptoms of serotonin syndrome were noted in 0.1% of patients
treated with VIIBRYD. Serotonin syndrome symptoms may include mental status changes (eg, agitation, hallucinations, coma), autonomic instability
(eg, tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (eg, hyperreflexia, incoordination) and/or gastrointestinal
symptoms (eg, nausea, vomiting, diarrhea). Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms
while treated with VIIBRYD.
- Like other antidepressants, VIIBRYD should be prescribed with caution in patients with a seizure disorder.
- The use of drugs that interfere with serotonin reuptake, including VIIBRYD, may increase the risk of bleeding events. Patients should be
cautioned about the risk of bleeding associated with the concomitant use of VIIBRYD and NSAIDs, aspirin, warfarin, or other drugs that affect
coagulation or bleeding.
- Symptoms of mania/hypomania were noted in 0.1% of patients treated with VIIBRYD in clinical studies. As with all antidepressants, VIIBRYD
should be used cautiously in patients with a history or family history of bipolar disorder, mania or hypomania.
- Prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are
at risk for bipolar disorder. VIIBRYD is not approved for use in treating bipolar depression.
- Discontinuation symptoms have been reported with discontinuation of serotonergic drugs such as VIIBRYD. Gradual dose reduction is recommended,
instead of abrupt discontinuation, whenever possible. Monitor patients when discontinuing VIIBRYD. If intolerable symptoms occur following a dose
decrease or upon discontinuation of treatment, consider resuming the previously prescribed dose and decreasing the dose at a more gradual
- Advise patients that if they are treated with diuretics, or are otherwise volume depleted, or are elderly, they may be at greater risk of
developing hyponatremia while taking VIIBRYD. Although no cases of hyponatremia resulting from VIIBRYD treatment were reported in the clinical
studies, hyponatremia has occurred as a result of treatment with SSRIs and SNRIs. Discontinuation of VIIBRYD in patients with symptomatic
hyponatremia and appropriate medical intervention should be instituted.
- The most commonly observed adverse reactions in MDD patients treated with VIIBRYD in placebo-controlled studies (incidence ≥5% and at least
twice the rate of placebo) were: diarrhea (28% vs 9%), nausea (23% vs 5%), insomnia (6% vs 2%), and vomiting (5% vs 1%).
Please also see full Prescribing Information.