|Systematic (IUPAC) name|
|Licence data||US Daily Med:|
|Pregnancy cat.||C (US)|
|Legal status||℞-only (US)|
|Bioavailability||72% (Oral, with food)|
|Metabolism||Hepatic via CYP3A4|
|Excretion||Faecal and renal|
|Mol. mass||441.524 g/mol|
|(what is this?)|
Vilazodone (United States trade name Viibryd) is a serotonergic antidepressant developed by Clinical Data for the treatment of major depressive disorder. The chemical compound was originally developed by Merck KGaA (Germany). By 2009 two phase III clinical trials with positive results had been completed. Vilazodone was approved by the FDA for use in the United States to treat major depressive disorder on January 21, 2011. Vilazodone is also prescribed as a treatment for generalized anxiety disorder and obsessive compulsive disorder.
Major Depressive Disorder
According to two eight-week, randomized, double-blind, placebo-controlled trials in adults, vilazodone was reported to elicit an antidepressant response after one week of treatment. After eight weeks, subjects assigned to vilazodone 40mg daily dose (titrated over 2 weeks) experienced a significantly higher response rate than the group given placebo (44% vs 30%, P = .002). Remission rates for vilazodone were not significantly different versus placebo.
According to an article on the the United States approval of Vilazodone written by FDA staff, "it is unknown whether [vilazodone] has any advantages compared to other drugs in the antidepressant class."
After a one-year, open-label study assessing the safety and tolerability of vilazodone in patients with major depressive disorder, the most common adverse effects were diarrhea (35.7%), nausea (31.6%), and headache (20.0%); greater than 90% of these adverse effects were mild or moderate. In contrast to other SSRIs currently on the market, initial clinical trials showed that vilazodone did not cause significant decreased sexual desire/function as with many other antidepressants, which often cause people to abandon their use.
Incidence of adverse effects
- Very common adverse effects (incidence >10%)
- Sleep paralysis
- Common adverse effects (1-10% incidence)
- Dry mouth
- Uncommon adverse effects (0.1-1% incidence)
- Abnormal dreams
- Libido decreased
- Restless legs syndrome
- Abnormal orgasms (male patients only)
- Delayed ejaculations (male patients only)
- Erectile dysfunction (male patients only)
- Feeling jittery
- Ventricular premature contractions
- Increased appetite
- Rare adverse effects (<0.1% incidence)
- Serotonin syndrome — a serious adverse effect characterised by:
- Mental status change (e.g. confusion, hallucinations, agitation, coma, stupor)
- Muscle rigidity
- Hyperreflexia — overresponsive/overactive reflexes
- Hyperthermia — elevated body temperature
- Autonomic instability (e.g. tachycardia, dizziness, abnormally excessive sweating, etc.)
- Mania/hypomania — a potentially dangerously elated/agitated mood. Every antidepressant has the potential to induce these psychiatric reactions. They are particularly problematic in those with a history of hypomania/mania such as those with bipolar disorder.
- Unknown-incidence adverse effects
- Suicidal ideation — all antidepressants can cause suicidal ideation especially in young adults and adolescents under the age of 25.
- Abnormal bleeding — the SSRIs are known for their ability to increase the incidence of gastrointestinal bleeds and other bleeding abnormalities.
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) — a condition characterised by an abnormally excessive secretion of antidiuretic hormone causing potentially-fatal electrolyte abnormalities (such as hyponatraemia).
- Hyponatraemia (a complication of the former) — low blood sodium.
Adverse reactions of VIIBRYD at doses of 200-280 mg included serotonin syndrome, lethargy, restlessness, hallucinations, and disorientation.
Vilazodone acts as a serotonin reuptake inhibitor (IC50 = 2.1 nM; Ki = 0.1 nM) and 5-HT1A receptor partial agonist (IC50 = 0.2 nM; IA = ~60–70%). It has negligible affinity for other serotonin receptors such as 5-HT1D, 5-HT2A, and 5-HT2C.
Partial agonism of the 5-HT1A receptor is a relatively novel mechanism of action and is also shared by the anxiolytic buspirone (Buspar), the atypical antipsychotics aripiprazole (Abilify) and lurasidone (Latuda) ,and the novel antidepressant vortioxetine (Brintellix).
Vilazodone is prescribed for major depressive disorder in doses ranging from 10 mg to 40 mg daily. Its half-life is approximately 25 hours.
Viibryd is available in tablet form as the hydrochloride salt of vilazodone in doses of 10 mg, 20 mg, and 40 mg. Inactive ingredients include lactose monohydrate, microcrystalline cellulose, magnesium stearate, colloidal silicon dioxide, polyvinyl alcohol, titanium dioxide, polyethylene glycol, talc, and various FD&C colorings (Blue #1, Yellow #6, Red #40) depending on the dose.
- "VIIBRYD (vilazodone hydrochloride) tablet VIIBRYD (vilazodone hydrochloride) kit [Forest Laboratories, Inc.]". DailyMed. Forest Laboratories, Inc. December 2012. Retrieved 28 October 2013.
- Clinical Data's Vilazodone Patient Enrollment Over One Third Complete. August 17th, 2006[dead link]
- de Paulis T (March 2007). "Drug evaluation: Vilazodone--a combined SSRI and 5-HT1A partial agonist for the treatment of depression". IDrugs : the Investigational Drugs Journal 10 (3): 193–201. PMID 17351874.
- "FDA approves Clinical Data Inc's antidepressant". Reuters. January 22, 2011.
- "FDA approves Clinical Data Inc's antidepressant". Reuters. January 22, 2011.
- "Clinical Data, Inc. - Clinical Data, Inc. Submits New Drug Application for Vilazodone for the Treatment of Major Depressive Disorder".
- Rickels K, Athanasiou M, Robinson DS, Gibertini M, Whalen H, Reed CR (March 2009). "Evidence for efficacy and tolerability of vilazodone in the treatment of major depressive disorder: a randomized, double-blind, placebo-controlled trial". The Journal of Clinical Psychiatry 70 (3): 326–33. PMID 19284933.
- USA (2013-01-30). "A randomized, double-blind, placebo-controlled, 8-week study of vilazodone, a serotonergic agent for the treatment of major depressive disorder". Ncbi.nlm.nih.gov. Retrieved 2013-02-28.
- Laughren TP, Gobburu J, Temple RJ, Unger EF, Bhattaram A, Dinh PV, Fossom L, Hung HM, Klimek V, Lee JE, Levin RL, Lindberg CY, Mathis M, Rosloff BN, Wang SJ, Wang Y, Yang P, Yu B, Zhang H, Zhang L, Zineh I (September 2011). "Vilazodone: clinical basis for the US Food and Drug Administration's approval of a new antidepressant". The Journal of Clinical Psychiatry 72 (9): 1166–73. doi:10.4088/JCP.11r06984. PMID 21951984.
- USA (2013-01-30). "A 1-year, open-label study assessing the safety and tolerability of vilazodone in patients with major depressive disorder". Ncbi.nlm.nih.gov. Retrieved 2013-02-28.
- Australian Medicines Handbook 2013. The Australian Medicines Handbook Unit Trust; 2013.
- Taylor D, Paton C, Kapur S, Taylor D. The Maudsley prescribing guidelines in psychiatry. 11th ed. Chichester, West Sussex: John Wiley & Sons; 2012.
- Wang Y-P, Chen Y-T, Tsai C-F, Li S-Y, Luo J-C, Wang S-J, et al. Short-Term Use of Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Bleeding. Am J Psychiatry [Internet]. 2013 Sep 13 [cited 2013 Oct 6]; Available from: http://ajp.psychiatryonline.org/article.aspx?articleid=1738031
- Page ME, Cryan JF, Sullivan A, et al. (September 2002). "Behavioral and neurochemical effects of 5-(4-[4-(5-Cyano-3-indolyl)-butyl)-butyl]-1-piperazinyl)-benzofuran-2-carboxamide (EMD 68843): a combined selective inhibitor of serotonin reuptake and 5-hydroxytryptamine(1A) receptor partial agonist". The Journal of Pharmacology and Experimental Therapeutics 302 (3): 1220–7. doi:10.1124/jpet.102.034280. PMID 12183683.
- Hughes ZA, Starr KR, Langmead CJ, et al. (March 2005). "Neurochemical evaluation of the novel 5-HT1A receptor partial agonist/serotonin reuptake inhibitor, vilazodone". European Journal of Pharmacology 510 (1–2): 49–57. doi:10.1016/j.ejphar.2005.01.018. PMID 15740724.