Nursing Implications for VORTIOXETINE Brintellix

VORTIOXETINE 

(vor-ti-ox′e-teen) Brintellix 
Classifications: ANTIDEPRESSANT; SEROTONIN MODULATOR
Therapeutic: ANTIDEPRESSANT
Pregnancy Category: C

AVAILABILITY 
Tablet

ACTION & THERAPEUTIC EFFECT 
Mechanism of action unknown but thought to be through inhibition of the reuptake of serotonin (5-HT), 5-HT3 receptor antagonism, and 5-HT1A receptor agonism. Enhanced serotonergic activity in the CNS is believed to produce an antidepressant effect.

USES 
Treatment of major depressive disorder (MDD).

CONTRAINDICATIONS 
Hypersensitivity to vortioxetine including angioedema; suicidal ideation; MAOIs within 14 days of starting vortioxetine or 21 days of stopping vortioxetine; serotonin syndrome; symptomatic hyponatremia; severe hepatic impairment; lactation.

CAUTIOUS USE 
History of suicidal thoughts; history of or family history of bipolar disorder, mania, or hypomania; history of bleeding disorders; history of GI bleeding; mild to moderate hepatic impairment; older adults; pregnancy (category C). Safety and efficacy in children have not been established.

ROUTE & DOSAGE 
Major Depressive Disorder
Adult: PO 10 mg once daily; may increase to 20 mg or decrease to 5 mg as needed or tolerated

Metabolism Dosage Adjustment 
Use with a strong CYP2D6 inhibitor: Decrease dose by 50% Use with a strong CYP2D6 inducer: Increase dose up to 3 × normal Use in patients who are poor CYP2D6 metabolizers: Maximum dose is 10 mg once daily

NURSING IMPLICATIONS VORTIOXETINE Brintellix

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ADMINISTRATION 
Oral 

• May give without regard to food. 
• To avoid adverse reactions, it is recommended that doses of 15– 20 mg/day be decreased to 10 mg/day for one wk before discontinuation. 
• Store at 15°–30° C (59°–86° F). 

ADVERSE EFFECTS (≥2%) 
CNS: Abnormal abnomal dreams, dizziness. CV: Constipation, diarrhea, dry mouth, flatulence, nausea, vomiting. Metabolic: Hyponatremia. Skin: Pruritus. Urogenital: Sexual dysfunction.

INTERACTIONS 
Drug: Coadministration of other drugs that affect serotonin transmission (e.g., SSRIs, SNRIs, TRIPTANS, buspirone, tramadol) may increase the risk of serotonin syndrome. Strong CYP2D6 inhibitors (e.g., bupropion, fluoxetine, paroxetine, quinidine) may increase the levels of vortioxetine. Strong CYP2D6 inducers (e.g., carbamazepine, phenytoin, rifampin) may decrease the levels of vortioxetine. Food: Tryptophan containing foods may increase the risk of serotonin syndrome.

PHARMACOKINETICS 
Absorption: 75% bioavailable. Peak: 7–11 h. Distribution: 98% plasma protein bound. Metabolism: Hepatic oxidation. Elimination: Renal (59%) and fecal (26%). Half- Life: 66 h.

NURSING IMPLICATIONS 

Black Box Warning 
Vortioxetine has been associated with suicidal thinking and behavior in children, adolescents, and young adults. 

Assessment & Drug Effects

• Report immediately to prescriber signs of worsening mental status such as suicidal ideation, aggressiveness, agitation, anxiety, hostility, impulsivity, insomnia, irritability, panic attacks, and worsening of depression. 
• Monitor for S&S of serotonin syndrome (see Appendix F). If serotonin syndrome is suspected withhold drug, notify prescriber and initiate supportive treatment. 
• Monitor for and report promptly S&S of hyponatremia (see Appendix F) and any signs of abnormal bleeding. 
• Monitor lab tests: Periodic serum sodium. 

Patient & Family Education 

• Report promptly to prescribe suicidal ideation or behavior, aggressive or impulsive behavior, worsening depression or anxiety, mania or unusual changes in behavior or mood. 
• Do not take OTC supplements such as tryptophan or St. John’s wort without consulting prescriber.
• Inform prescriber if you are taking OTC nonsteroidal antiinflammatory drugs (NSAIDs) or aspirin for pain relief. 
• Report promptly any of the following: S&S of serotonin syndrome (see Appendix F); abnormal bleeding; S&S of low serum sodium (see hyponatremia Appendix F). 
• Notify prescriber immediately if you are or suspect you are pregnant. 
• Do not breast-feed while taking this drug.

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Ditulis oleh Unknown pada tanggal Friday, July 10, 2015