Multimodal Antidepressant — Serotonin Modulator Pregnancy: There are limited data in pregnant women and animal studies have shown reproductive toxicity; Brintellix should only be given to pregnant women if the expected benefits outweigh the potential risk to the foetus. Maternal use of a serotonergic medicine in later pregnancy may cause neonatal symptoms (respiratory distress, cyanosis, apnoea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycaemia, hyper/hypotonia, hyperreflexia, tremor, jitteriness, irritability, lethargy, constant crying, somnolence, difficulty sleeping); a potential risk of persistent pulmonary hypertension of the newborn and of postpartum haemorrhage cannot be ruled out. Breast-feeding: excreted in small amounts (estimated relative infant dose below 2%) — a risk to the breast-fed child cannot be excluded.

Vortioxetine

Brand names: Brintellix, Trintellix

Vortioxetine is an antidepressant used to treat major depressive disorder in adults.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg once daily (starting and recommended dose in adults less than 65 years of age)

Route: Oral (film-coated tablets)

Frequency: Once daily, with or without food

Max: 20 mg once daily

UK SPC (Brintellix 10 mg film-coated tablets, eMC product 10441): 'The starting and recommended dose of Brintellix is 10 mg vortioxetine once daily in adults less than 65 years of age. Depending on individual patient response, the dose may be increased to a maximum of 20 mg vortioxetine once daily or decreased to a minimum of 5 mg vortioxetine once daily.' After the depressive symptoms resolve, treatment for at least 6 months is recommended for consolidation of the antidepressive response. Elderly: 'The lowest effective dose of 5 mg vortioxetine once daily should always be used as the starting dose in patients 65 years of age and over'; caution with doses above 10 mg once daily in this group as data are limited. Discontinuation: a gradual reduction in dosage may be considered to avoid discontinuation symptoms, but the SPC states there are insufficient data to provide specific recommendations for a tapering schedule. Paediatrics: 'Brintellix should not be used in paediatric patients (under 18 years of age) with major depressive disorder (MDD) because efficacy has not been demonstrated' (and should not be used in children and adolescents aged 7 to 17 years with MDD; a higher incidence of suicidal ideation was seen in adolescents than in adults). US labelling (TRINTELLIX) differs on target dose: start 10 mg once daily then increase to 20 mg/day as tolerated, consider 5 mg/day if higher doses are not tolerated; maximum 10 mg/day in known CYP2D6 poor metabolisers; halve the dose with a strong CYP2D6 inhibitor. eMC section 4.5 was not fetched in this bundle; the interactions listed are those stated within the fetched sections 4.2, 4.3 and 4.4, and sections 4.4 and 4.8 were truncated at the source-fetch limit.

Dose adjustments

Renal

No dose adjustment is needed based on renal or hepatic function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Concomitant use with non-selective monoamine oxidase inhibitors (MAOIs) or selective MAO-A inhibitors

Side effects

Nausea (very common; usually mild or moderate, within the first two weeks, usually transient)
Diarrhoea (common)
Constipation (common)
Vomiting (common)
Dizziness (common)
Pruritus and hyperhidrosis (common); abnormal dreams (common)

Interactions

Non-selective MAOIs and selective MAO-A inhibitors — concomitant use is contraindicated
Strong CYP2D6 inhibitors (e.g. bupropion, quinidine, fluoxetine, paroxetine) — a lower dose of vortioxetine may be considered depending on individual patient response
Broad cytochrome P450 inducers (e.g. rifampicin, carbamazepine, phenytoin) — a dose adjustment of vortioxetine may be considered
Other serotonergic substances (including opioids and triptans), medicines that impair serotonin metabolism (including MAOIs), antipsychotics and other dopamine antagonists — increased risk of serotonin syndrome or neuroleptic malignant syndrome

Clinical monograph

How it works

It inhibits the serotonin transporter while also acting as an agonist, partial agonist or antagonist at several serotonin receptor subtypes, producing a multimodal effect on serotonergic neurotransmission.

Prescribing in practice

Carries a risk of serotonin syndrome, particularly when combined with other serotonergic agents or MAO inhibitors, which are contraindicated.
Nausea is the most common adverse effect and tends to diminish over the first few weeks of treatment.
Withdraw gradually where feasible and monitor for suicidal ideation, especially in younger adults during early treatment.

Monitoring

Monitor mood, response and emergence of suicidal ideation, especially during initiation and dose changes.

Counselling the patient

It may take several weeks before the full antidepressant benefit is felt.
Report any agitation, confusion, fever or muscle twitching promptly.
Do not stop the medicine abruptly without medical advice.

Evidence & guidelines

NICE recommends antidepressants as an option for moderate to severe depression alongside psychological therapy.

Reference: Alvarez et al. Int J Neuropsychopharmacol 2014; McIntyre et al. J Psychopharmacol 2014 (FOCUS); NICE NG222; MHRA SPC Brintellix; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways