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vilazodone

Adjunctive therapy

Brands: Viibryd

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

  • What is vilazodone?

    Vilazodone (Viibryd) is a serotonin reuptake inhibitor and 5-HT1A partial agonist approved for adult major depressive disorder; it offers an SSRI-like efficacy profile with a modest signal for less sexual dysfunction in some comparative studies.

  • What is Viibryd?

    Viibryd is a brand name for vilazodone.

  • What is Viibryd (vilazodone) used for?

    Label indications include: Major depressive disorder.

  • What drug class is Viibryd (vilazodone)?

    Serotonin reuptake inhibitor and 5-HT1A partial agonist.

  • What strengths does Viibryd (vilazodone) come in?

    Film-coated tablets: 10 mg, 20 mg, 40 mg.

Snapshot

  • Class: Adjunctive therapy
  • Common US brands: Viibryd
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-29

Label indications

Major depressive disorder.

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Clinical Highlights

Vilazodone (Viibryd) is a serotonin reuptake inhibitor and 5-HT1A partial agonist approved for adult major depressive disorder; it offers an SSRI-like efficacy profile with a modest signal for less sexual dysfunction in some comparative studies. The compare view and the vilazodone evidence feed can help compare food requirements, activation, and sexual dysfunction rates before switching regimens.

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  • Because food increases exposure twofold, every dose must be taken with a meal (≥350 calories)—a critical counseling point to avoid treatment failure in serious mental illness care plans.
  • Consider for patients who experienced SSRI-related sexual dysfunction or weight gain, but reinforce food-dependent absorption and GI tolerability strategies during titration.
  • Major depressive disorder (FDA 2011)
  • Generic: Generics launched in 2023–2024; verify formulary status because some payers retain brand prior authorization requirements.

Dosing & Formulations

Film-coated tablets: 10 mg, 20 mg, 40 mg. Initiate 10 mg once daily with food for 7 days, increase to 20 mg once daily for 7 days, then advance to 40 mg once daily with food if tolerated.

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  • Limit to 20 mg/day when co-administered with strong CYP3A4 inhibitors (ketoconazole, clarithromycin); monitor carefully with moderate inhibitors. Avoid strong CYP3A4 inducers (carbamazepine, rifampin, St. John’s wort) because exposure is markedly reduced.
  • If therapy is interrupted for >3 days, restart the titration to minimize GI adverse effects; taper to 20 mg then 10 mg over at least 1 week when discontinuing to limit withdrawal symptoms.

Monitoring & Risks

Boxed warning: Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults—monitor closely during initiation and dose changes. Diarrhea: Most frequent adverse effect; often improves after the first 1–2 weeks—taking with food helps.

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  • Nausea: Mitigated by gradual titration and morning dosing with meals.
  • Insomnia or vivid dreams: Prefer morning administration and assess for activation.
  • Headache and dizziness: Usually transient; educate on fall precautions during titration.
  • Activation/anxiety, especially during early titration—consider slower titration if patients report jitteriness.

Drug Interactions

Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin) increase exposure—limit to 20 mg/day; monitor when moderate inhibitors are used. Strong CYP3A4 inducers (carbamazepine, rifampin, phenytoin, St. John’s wort) significantly lower concentrations; avoid combination or select an alternative antidepressant.

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  • Contraindicated with MAOIs, linezolid, and methylene blue—observe 14-day washouts to reduce serotonin syndrome risk.
  • Additive serotonergic effects with SSRIs, SNRIs, triptans, lithium, or tramadol; counsel on serotonin syndrome symptoms and monitor closely.
  • Heightened bleeding risk when combined with NSAIDs, antiplatelets, or anticoagulants—ensure gastroprotection when appropriate.

Practice Notes

Counsel patients to take vilazodone with a substantial meal at the same time each day; missed doses taken without food may deliver subtherapeutic exposure. Monitor for early insomnia, restlessness, and GI upset; supportive care (taking with breakfast, hydration, antidiarrheals) can improve adherence. Revisit the bipolar disorder hub if screening uncovers mixed features or mood destabilization.

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  • Discuss pregnancy planning; data are limited, so weigh maternal benefit versus fetal risk and coordinate with obstetrics for individualized decisions.

References

  1. Vilazodone hydrochloride tablets prescribing information — DailyMed (2023)
  2. Vilazodone for major depressive disorder: systematic review of efficacy and safety — International Journal of Clinical Practice (2012)
  3. Vilazodone, levomilnacipran and vortioxetine for major depressive disorder — International Journal of Clinical Practice (2015)
  4. Vilazodone IN Major Depressive Disorder: Randomized, Active AND Placebo Controlled Trial — Cureus (2021)
  5. APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
  6. CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Vilazodone (Viibryd) — Summary — PsychMed