Drug Interactions between Quin-Release and Trintellix

ADJUST DOSE: Coadministration with potent inhibitors of CYP450 2D6 may significantly increase the plasma concentrations of vortioxetine, which is primarily metabolized by the isoenzyme. According to the product labeling, administration of vortioxetine with the potent CYP450 2D6 inhibitor bupropion resulted in greater than 2-fold increases in vortioxetine peak plasma concentration (Cmax) and systemic exposure (AUC) compared to administration of vortioxetine alone. High plasma levels of vortioxetine may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: The dosage of vortioxetine should be reduced by one-half when used in combination with potent CYP450 2D6 inhibitors such as bupropion, cinacalcet, fluoxetine, paroxetine, quinidine, ritonavir, and terbinafine. Following discontinuation of the potent CYP450 2D6 inhibitor, vortioxetine dosage should be returned to the original level. Since fluoxetine and paroxetine are also selective serotonin reuptake inhibitors, additive serotonergic effects with vortioxetine should be considered, and concomitant use avoided if possible.

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