Vilazodone (viibryd) - Dose, side effects, brands

Vilazodone is a selective serotonin reuptake inhibitor with little effect on dopamine and norepinephrine.

It is used to treat Major depressive disorder:

Vilazodone Dose in Adults

Dose in the treatment of Major depressive disorder (MDD):

- 10 mg orally 1 tablet daily as a single tablet for 7 days, then increase to 20 mg/ day;
- max 40mg/day, increase dose only weekly basis.
Discontinuation of therapy:
- When discontinuing antidepressant treatment, if used for more than 3 weeks, the dose is gradually decreased (eg, over a period of 2 to 4 weeks) to minimize withdrawal symptoms and detect reemerging symptoms.
- Manufacturer labeling recommends:
  - Patients taking 40 mg/day, taper dose to 20 mg/day for 4 days, then 10 mg/day for 3 days
  - Patients taking 20 mg/day, taper dose to 10 mg/day for 7 days.
- Reasons for a slowly titrating the dose (eg, over 4 weeks) include the use of a drug with a half-life of fewer than 24 hours (eg, paroxetine, venlafaxine), prior history of antidepressant withdrawal symptoms, or patients on high doses of antidepressants.
- In case intolerable withdrawal symptoms occur, take the patient on the previously prescribed dose and/or decrease dose at a more slowly.
- Select patients (eg, those with a history of discontinuation syndrome) on long-term treatment (more than 6 months) may benefit from tapering over >3 months.

MAO inhibitor recommendations:
- Switching from or to an MAO inhibitor to treat psychiatric disorders:
  - There should be 14 days gap between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of vilazodone and vice versa.
Use with other MAO inhibitors (IV methylene blue or linezolid):
- In patients receiving linezolid or intravenous methylene blue, consider other interventions for a psychiatric condition.
- The use of MAOs and vilazodone is not recommended in patients taking the above medications.
- In cases where urgent treatment with linezolid or IV Methylene blue in patients already taking vilazodone, and potential benefits outweigh potential risks, vilazodone can be discontinued abruptly and administer linezolid or IV methylene blue.
- Monitoring for serotonin syndrome is required for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first.
- Vilazodone can be restarted 24 Hrs after the last dose of linezolid or IV methylene blue.

Dosing adjustment for concomitant medications:
- Drugs which are strong inhibitors of CYP3A4 (eg, clarithromycin, itraconazole, voriconazole):
  - The maximum dose for vilazodone with such drugs is 20mg/day.
  - Resume the original dose of vilazodone after discontinuation of CYP3A4 inhibitors.
- Drugs which are strong inducers of CYP3A4 (eg, carbamazepine, phenytoin, rifampin):
  - Consider increasing the dose 2-fold(max dose - 80mg/day) when used at the same time for more than 14 days based on clinical response to vilazodone.
- Maximum daily dose:
  - 80 mg. Resume the original dose of vilazodone after discontinuation of CYP3A4 inducer over 7 to 14 days.

Vilazodone Dose in Childrens

Not recommended for use in children

Pregnancy Risk Factor: C

Use of Vilazodone (viibryd), during lactation
Studies on animal reproduction have shown that there are adverse events.
Mothers who use other SSRIs may have an increased chance of experiencing adverse events.
However, it is not known if vilazodone can be teratogenic.
Mothers who used the drug may have non-teratogenic effects on their newborns.SSRISNRI late during the third trimester of pregnancy, such as:
- Respiratory distress
- Cyanosis
- Temperature instability
- Apnea
- Seizure
- Vomiting
- Feeding difficulty
- Hypoglycemia
- Hypotonia and hypertonia.
- Hyperreflexia
- Chitteriness
- Irritation
- Tremors and
- Constant crying.
Possible to cause persistent pulmonary hypertension in the newborn (PPHN), if SSRIs are used.
ACOG recommends that therapy with SSRIs and SNRIs during pregnancy is individualized
The clinical expertise of the mental healthcare clinician, the obstetrician and primary healthcare provider should all be used to treat depression in pregnancy.
Pregnant women should not be exposed to untreated depression.
Women who have stopped taking antidepressants during pregnancy can resume their medication after delivery. However, they may be at risk for postpartum depression.
Pregnant women should use a safer alternative medication.

Vilazodone Use During Breastfeeding:

It is unknown if Vilazodone is excreted in breast milk.
If the benefits are greater than the risks, continue using it.
Pregnancy with vilazodone may result in delayed milk production. Studies on long-term effects of vilazodone on behavior and development are still ongoing.

Vilazodone Dose in Renal Disease:

No dosage adjustment is necessary.

Vilazodone Dose in Liver Disease:

No dosage adjustment is necessary.

Common Side Effects of Vilazodone (viibryd) Include:

Central nervous system:
- Headache
Gastrointestinal:
- Diarrhea
- Nausea

Less Common Side Effects of Vilazodone (viibryd) Include:

Cardiovascular:
- Palpitations
Central Nervous System:
- Dizziness
- Insomnia
- Drowsiness
- Fatigue
- Abnormal Dreams
- Restlessness
- Paresthesia
- Delayed Ejaculation
- Migraine
- Sedation
- Panic Attack
- Ventricular Premature Contractions
Dermatologic:
- Hyperhidrosis
- Night Sweats
Endocrine & Metabolic:
- Decreased Libido
- Weight Gain
Gastrointestinal:
- Xerostomia
- Abdominal Pain
- Vomiting
- Dyspepsia
- Flatulence
- Increased Appetite
- Abdominal Distension
- Gastroenteritis
Genitourinary:
- Erectile Dysfunction
- Orgasm Disturbance
Neuromuscular & Skeletal:
- Arthralgia
- Tremor
Ophthalmic:
- Blurred Vision
- Xerophthalmia

Contraindication to Vilazodone Include:

Use of an MAO inhibitor in conjunction with vilazodone. (including MAO inhibitors like intravenous Methylene Blue or linezolid).
Allergy to vilazodone and any component of the formulation

Warnings and Precautions

Bleeding Risk:
- The risk of bleeding is higher when it interferes with platelet aggregation.
- This is especially true if the medication is taken in combination with NSAIDs, warfarin or other anticoagulants such as aspirin.
- Reports of bleeding, including GI bleeding, have been reported in connection to the use SSRI and SNRI.
- These bleeding range from minor bruising and epistaxis up to life-threatening hemorhage.
Fractures
- Antidepressant therapy has been linked to bone fractures.
- Fragility fractures should be considered for patients with undiagnosed bone pain, tenderness, bruising or swelling.
Ocular effects
- Sensitive individuals may be at risk for a mild case of narrow-angle, or even fatal, glaucoma.
- Patients who have not had an iridectomy to reduce narrow-angle glaucoma risks factors are required to be evaluated.
Serotonin syndrome
- Serotonin syndrome can be a potentially life-threatening adverse reaction to serotonergic drugs (eg SSRIs, SNRIs), especially when combined with other serotonergic medications (eg triptans TCAs or fentanyl), such as buspirone, fentanyl and tramadol, fentanyl.
- Serotonin syndrome is a condition in which patients are closely monitored for signs and symptoms such as mental changes, agitation, hallucinations or delirium, coma, autonomic instability (eg tachycardias, labile pressure, diaphoresis), neuromuscular disorders (eg tremors, rigidity, myoclonus), GI symptoms (eg nausea, vomiting, diarrhea) and/or seizures.
- If signs/symptoms appear, the treatment must be stopped immediately.
Sexual dysfunction
- This can lead to or worsen existing dysfunction.
SIADH and Hyponatremia
- SIADH was developed through the use of SSRIs/SNRIs.
- Hyponatremia has been reported, with severe cases of serum sodium 110 mg/L. This is most common in the elderly.
- This condition can be reversed and resolved by stopping the drug.
- Concurrent use of diuretics increases the risk of volume loss.
Hypomania and mania:
- Bipolar disorder patients may experience worsening psychosis, or a shift towards mania or hypomania.
- Before starting treatment, patients must be screened for a family or personal history of bipolar disorder or mania.
Seizure disorder
- Patients with a history of seizure disorders or other conditions that can lead to seizures, such as brain damage or addiction, should be cautious.

Vilazodone: Drug Interaction

Risk Factor C (Monitor therapy)
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.
Anticoagulants	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.
Antiemetics (5HT3 Antagonists)	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Antipsychotic Agents	Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Apixaban	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely.
Aspirin	Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Aspirin.
Beta-Blockers	Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Beta-Blockers. Exceptions: Acebutolol; Atenolol; Betaxolol (Ophthalmic); Betaxolol (Systemic); Bisoprolol; Carteolol (Ophthalmic); Esmolol; Labetalol; Levobunolol; Metipranolol; Nadolol; Sotalol.
Blood Glucose Lowering Agents	Selective Serotonin Reuptake Inhibitors may enhance the hypoglycemic effect of Blood Glucose Lowering Agents.
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Brexanolone	Selective Serotonin Reuptake Inhibitors may enhance the CNS depressant effect of Brexanolone.
BuPROPion	May enhance the adverse/toxic effect of Vilazodone. Specifically, the risk for seizures and serotonin syndrome may be increased.
Cephalothin	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.
CNS Depressants	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Collagenase (Systemic)	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May increase the serum concentration of Vilazodone.
Cyproheptadine	May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.
Dabigatran Etexilate	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Dabigatran Etexilate. Agents with Antiplatelet Properties may increase the serum concentration of Dabigatran Etexilate. This mechanism applies specifically to clopidogrel. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.
Dasatinib	May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Deoxycholic Acid	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.
Desmopressin	Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Desmopressin.
Digoxin	Vilazodone may increase the serum concentration of Digoxin.
Edoxaban	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased.
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Fat Emulsion (Fish Oil Based)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Glucosamine	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Ibritumomab Tiuxetan	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.
Ibrutinib	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Inotersen	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Ioflupane I 123	Selective Serotonin Reuptake Inhibitors may diminish the diagnostic effect of Ioflupane I 123.
Ivosidenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Limaprost	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Metaxalone	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Methylphenidate	May enhance the adverse/toxic effect of Serotonin Modulators. Specifically, the risk of serotonin syndrome or serotonin toxicity may be increased.
MetyroSINE	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.
Multivitamins/Fluoride (with ADE)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with ADEK, Folate, Iron)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with AE, No Iron)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.
Nonsteroidal Anti-Inflammatory Agents (Topical)	May enhance the antiplatelet effect of Selective Serotonin Reuptake Inhibitors.
Obinutuzumab	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.
Omega-3 Fatty Acids	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Opioid Agonists	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Pentosan Polysulfate Sodium	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.
Pentoxifylline	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Prostacyclin Analogues	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
RisperiDONE	Selective Serotonin Reuptake Inhibitors may decrease the metabolism of RisperiDONE.
Rivaroxaban	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Rivaroxaban. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Serotonin Modulators	May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid.
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Tedizolid	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Thiazide and Thiazide-Like Diuretics	Selective Serotonin Reuptake Inhibitors may enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics.
Thrombolytic Agents	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.
Thyroid Products	Selective Serotonin Reuptake Inhibitors may diminish the therapeutic effect of Thyroid Products. Thyroid product dose requirements may be increased.
Tipranavir	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
TraMADol	Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Vitamin E (Systemic)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Vitamin K Antagonists (eg, warfarin)	Selective Serotonin Reuptake Inhibitors may enhance the anticoagulant effect of Vitamin K Antagonists.
Risk Factor D (Consider therapy modification)
Alcohol (Ethyl)	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors.
Bemiparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
BusPIRone	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Management: The combination of a selective serotonin reuptake inhibitor and buspirone should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.
CYP3A4 Inducers (Strong)	May decrease the serum concentration of Vilazodone. Management: Consider increasing vilazodone dose by as much as 2-fold (do not exceed 80 mg/day), based on response, in patients receiving strong CYP3A4 inducers for > 14 days. Reduce to the original vilazodone dose over 1-2 weeks after inducer discontinuation.
CYP3A4 Inhibitors (Strong)	May increase the serum concentration of Vilazodone. Management: Limit maximum adult vilazodone dose to 20 mg daily in patients receiving strong CYP3A4 inhibitors. The original vilazodone dose can be resumed following discontinuation of the strong CYP3A4 inhibitor.
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Dextromethorphan	Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Dextromethorphan. Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dextromethorphan. Management: Avoid the concurrent use of dextromethorphan and SSRIs, particularly fluoxetine and paroxetine, when possible. The risk for this interaction may persist for several weeks following discontinuation of fluoxetine or paroxetine.
Enoxaparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Gilteritinib	May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Avoid use of this combination if possible. If the combination cannot be avoided, monitor closely for evidence of reduced response to the selective serotonin reuptake inhibitor.
Heparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.
Linezolid	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could result in serotonin syndrome. Management: Consider alternatives to this combination whenever possible. If clinically acceptable, wait at least 2 weeks (5 weeks for fluoxetine) after SSRI discontinuation to initiate linezolid.
Linezolid	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Due to a risk of serotonin syndrome/serotonin toxicity, discontinue serotonin modulators 2 weeks prior to the administration of linezolid. If urgent initiation of linezolid is needed, discontinue serotonin modulators immediately and monitor closely.
Lithium	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could increase the risk of serotonin toxicity/serotonin syndrome. Management: This combination should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Metoclopramide	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Management: Seek alternatives to this combination when possible. Monitor patients receiving metoclopramide with selective serotonin reuptake inhibitors for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Nonsteroidal Anti-Inflammatory Agents (Nonselective)	Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2selective NSAIDs reduce risk. Exceptions: Diclofenac (Topical); Ibuprofen (Topical); Piroxicam (Topical).
Pitolisant	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant.
Serotonin Reuptake Inhibitor/Antagonists	Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Serotonin Reuptake Inhibitor/Antagonists. This may cause serotonin syndrome. Management: Consider alternatives, and use conservative initial dosing. Monitor patients receiving these combinations for signs/symptoms of serotonin toxicity.
St John's Wort	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Risk Factor X (Avoid combination)
Bromopride	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.
Dapoxetine	May enhance the adverse/toxic effect of Serotonin Modulators.
Dothiepin	Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dothiepin.
Methylene Blue	Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Methylene Blue. This could result in serotonin syndrome.
Methylene Blue	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Monoamine Oxidase Inhibitors	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details. Exceptions: Linezolid; Methylene Blue; Tedizolid.
Pimozide	Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Pimozide. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs as appropriate.
Tryptophan	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome.
Urokinase	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.

Monitor patients periodically for:

Treatment of symptoms
Depression and mental health
Suicidal thoughts (especially when the doses are increased/ decreased or at the beginning of therapy)
Anxiety
Social functioning
Mania
Panic attacks
Serotonin syndrome symptoms and signs
Akathisia

How to administer Vilazodone?

Should be taken with food.

Mechanism of action of Vilazodone (viibryd):

Vilazodone works by inhibiting serotonin uptake by CNS neurons.
There is minimal to no effect on norepinephrine or dopamine reuptake.
It also is a 5-HT-1A receptor partial agonist and selectively binds with high affinity to 5-HT-1A receptors.
Depression and anxiety may alter the activity of the 5-HT-1A receptor.

Protein binding: