Veozah
Veozah
Generic Name
Veozah
Mechanism
* Serotonin reuptake inhibition: Vilazodone blocks the serotonin transporter (SERT), increasing synaptic serotonin levels.
* 5‑HT1A partial agonism: Acts as a partial agonist at 5‑HT1A autoreceptors in the raphe nuclei and heteroreceptors in the prefrontal cortex. This dual activity contributes to a faster onset of antidepressant effect and a lower incidence of sexual dysfunction compared to traditional SSRIs.
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Pharmacokinetics
| Parameter | Description |
| Absorption | Oral bioavailability ~0.5–0.8; Tmax ≈ 2‑4 h (food increases absorption). |
| Metabolism | Primarily hepatic via CYP3A4 and CYP2C19; produces active metabolites. |
| Distribution | High plasma protein binding (~90 %); volume of distribution ~70 L. |
| Elimination | Half‑life ~36 h; 80 % excreted in feces, 10 % in urine. |
| Special Populations | Mild‑to‑moderate hepatic impairment: no dose adjustment. Mild renal impairment: no adjustment. Elderly: no dose adjustment needed, but monitor for adverse events. |
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Indications
* Major Depressive Disorder (MDD) – adults, ≥18 years.
* Off‑label use: anxiety disorders, obsessive‑compulsive disorder (OCD) – not FDA‑approved but occasionally prescribed.
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Contraindications
* Contraindications:
* Hypersensitivity to vilazodone or any excipient.
* Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation.
* Warnings:
* Serotonin syndrome: Risk increases when combined with other serotonergic agents (e.g., other SSRIs/SNRIs, tramadol, linezolid).
* Hyponatremia: Rare, especially in elderly.
* Hepatotoxicity: Monitor LFTs; rare cases of symptomatic hepatic injury.
* QTc prolongation: Minimal effect but caution with drugs that prolong QTc.
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Dosing
| Dose | Frequency | Notes |
| Initial dose: 10 mg PO once daily (first day). | Tolerability check | |
| Maintenance dose: 20 mg PO once daily. | Escalate if inadequate response after 4 weeks. | |
| Max dose: 20 mg/d. | Dose above 20 mg has not shown additional benefit and ↑ adverse events. | |
| Titration: 10 mg increments if needed (e.g., 20 mg → 30 mg not recommended). | Avoid dose escalation beyond 20 mg. | |
| Administration: With or without food. | Food slightly increases absorption; no strict timing relative to meals. | |
| Refill/Transition: No bridging dose needed; gradual tapering recommended to avoid discontinuation syndrome. | Taper 10 mg every 1–2 weeks or as clinically indicated. |
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Adverse Effects
| Adverse Effect | Incidence | Management |
| Nausea, gastrointestinal upset | 15‑20 % | Reduce dose; take with food; consider antiemetics. |
| Insomnia | 5‑10 % | Take earlier in day; adjust dose if persistent. |
| Headache, dizziness | 5‑10 % | Adequate hydration; monitor for syncope. |
| Sexual dysfunction | 1‑3 % | Rare; consider dose adjustment or switch if troublesome. |
| Dry mouth | 3‑5 % | Hydration; sugar‑free lozenges. |
| Weight change | <1 % | Monitor body weight. |
| Serotonin syndrome | <1 % (rare, with combinations) | Immediate discontinuation of serotonergic drugs; supportive care. |
| Hyponatremia | Rare | Monitor Na⁺ in the elderly or patients on diuretics. |
| Liver enzyme elevation | Rare | Check baseline and periodic LFTs. |
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Monitoring
| Parameter | Frequency | Rationale |
| Baseline LFTs | Prior to initiation | Detect pre‑existing hepatic dysfunction. |
| Electrolytes (Na⁺, K⁺) | Baseline; repeat if symptomatic or in elderly | Detect hyponatremia. |
| Serotonergic drug co‑prescriptions | Continuous | Identify risk of serotonin syndrome. |
| Weight, BMI | Every visit | Monitor for metabolic side effects. |
| Blood pressure, pulse | During dose titration | Screen for cardiovascular effects. |
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Clinical Pearls
* Fast‑track option: The 5‑HT1A partial agonism of Veozah typically yields a quicker antidepressant onset (≈3 weeks) relative to pure SSRIs.
* Sexual dysfunction advantage: Compared with other SSRIs, the incidence of sexual side effects is lower, making it a first‑line choice for patients with sexual dysfunction concerns.
* Food interaction: While food modestly increases AUC, it does not significantly alter Cmax; patients can take with or without meals.
* Renal/ hepatic dosing: Unlike many antidepressants, Veozah does not require dose adjustment in mild‑to‑moderate hepatic or renal impairment, simplifying prescribing in older adults.
* Clozapine interaction: Avoid concomitant use with clozapine because both are metabolized by CYP3A4; increased serum clozapine may lead to toxicity.
* Discontinuation syndrome prevention: Counsel patients on the risk of withdrawal symptoms after abrupt stop; implement a graded taper schedule.
* Pregnancy category: Limited human data; use only if benefit outweighs risk. Prefer breastfeeding‑safe alternatives in lactating patients.
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• Bottom line:
Veozah offers a unique combination of SSRI activity with 5‑HT1A agonism, making it an attractive option for adults with MDD who require a faster onset and lower sexual side‑effect profile. Careful attention to drug–drug interactions, particularly with other serotonergic agents, and routine monitoring for hepatic function and electrolyte abnormalities will maximize efficacy while minimizing harm.