Adults: Dosage for major depressive disorder
The recommended target dosage of vilazodone is 20 mg to 40 mg by mouth once daily with food. To reach it, start with 10 mg once daily with food for 7 days, then increase to 20 mg once daily with food. The dose can go up to 40 mg once daily with food, as long as at least 7 days pass between dosage increases.
If a dose is missed, the patient should take it as soon as they remember. If it's almost time for the next dose, they should skip the missed one and take the next dose at the regular time. Two doses should never be taken at the same time.
Prior screening for bipolar disorder
Before starting vilazodone or another antidepressant, screen patients for a personal or family history of bipolar disorder, mania or hypomania.
Switching to or from a monoamine oxidase inhibitor antidepressant
At least 14 days must pass between stopping a monoamine oxidase inhibitor (MAOI) antidepressant and starting vilazodone. The same gap applies the other way round: at least 14 days must pass after stopping vilazodone before an MAOI antidepressant is started.
Dose adjustments with CYP3A4 inhibitors or inducers
For patients also taking a strong CYP3A4 inhibitor (for example itraconazole, clarithromycin or voriconazole), the vilazodone dose should not go above 20 mg once daily. Once the CYP3A4 inhibitor is stopped, the original vilazodone dose can be resumed.
For patients taking a strong CYP3A4 inducer (for example carbamazepine, phenytoin or rifampin) for more than 14 days, consider increasing the vilazodone dosage by 2-fold, based on clinical response. The increase is made over 1 to 2 weeks, up to a maximum of 80 mg once daily. If the CYP3A4 inducer is stopped, bring the vilazodone dosage back down to its original level gradually, over 1 to 2 weeks.
Stopping treatment with vilazodone
Adverse reactions may occur when vilazodone is stopped. Wherever possible, the dose should be reduced gradually instead of stopping suddenly. From 40 mg once daily, taper to 20 mg once daily for 4 days, followed by 10 mg once daily for 3 days. Patients taking 20 mg once daily should be tapered to 10 mg once daily for 7 days.
