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Side Effects of Trintellix

Trintellix Oral : Uses, Side Effects

What is Trintellix?

Trintellix is an antidepressant used for the treatment of a type of mental disorder called major depressive disorder (MDD). The common side effects of this medication are:

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Just like other types of antidepressants, Trintellix also increases the risk of suicidal behavior and thoughts in adults and young adults, including adolescents and children. For this reason, it is very important to speak with your doctor if you have suicidal thoughts while on this medication. 

The initial recommended dosage of Trintellix is 10 mg per day, but may later be increased to 20 mg per day, as tolerated. 

You also need to inform your doctor if you are taking any medications or supplements before using Trintellix to avoid any drug interactions. The following medications may interact with Trintellix:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Aspirin
  • Tramadol
  • Triptans
  • Buspirone
  • Tryptophan supplements
  • Warfarin
  • Bupropion
  • Paroxetine
  • Fluoxetine
  • Quinidine
  • Carbamazepine
  • Rifampicin
  • Phenytoin

Side Effects of Trintellix

The following are some of the side effects of Trintellix:

1. Serotonin Syndrome

Serotonin syndrome is a potentially life-threatening drug reaction that occurs when there is an excessive level of serotonin in the body. Serotonergic antidepressants such as Trintellix may potentially cause serotonin syndrome, especially when it is used with other serotonergic drugs, such as:

  • Fentanyl
  • Tramadol
  • Lithium
  • Tryptophan
  • St. John's Wort
  • Buspirone
  • Tricyclic antidepressants
  • Triptans
  • Monoamine oxidase inhibitors (MAOIs) such as intravenous methylene blue and linezolid 

The symptoms of serotonin syndrome may include any of the following:

2. Hypersensitivity

Hypersensitivity to Trintellix or any components of vortioxetine has been reported in some cases. One significant hypersensitivity reaction after taking this medication is angioedema, which is the swelling of the lower layers of the tissues, skin, or mucous membranes. 

3. Angle-Closure Glaucoma

This type of glaucoma is characterized by pupillary dilation after taking antidepressants such as Trintellix. People who have anatomically narrow angles and do not have a patent iridectomy may experience an attack of angle closure glaucoma following Trintellix usage. 

4. Abnormal Bleeding 

The risk of abnormal bleeding increases when Trintellix and other drugs that interfere with serotonin reuptake inhibition are used. This risk also increases when these drugs are taken along with nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, warfarin, and other anticoagulant drugs. 

Abnormal bleeding may range from hematoma, petechiae, bruising, or epistaxis (nosebleeds) to certain life-threatening hemorrhages. Gastrointestinal bleeding has also been reported in some cases in which other selective serotonin reuptake inhibitors (SSRIs) are taken along with Trintellix. 

5. Hyponatremia

Hyponatremia is the medical term for low sodium levels in the blood. This condition may also occur after using serotonergic drugs. Hyponatremia may also be the result of the condition called syndrome of inappropriate antidiuretic hormone secretion (SIADH), in which the body produces excessive levels of antidiuretic hormone (ADH). 

The signs and symptoms of hyponatremia may include any of the following:

  • Unable to concentrate
  • Headaches
  • Confusion
  • Memory loss or impairment
  • Unsteadiness
  • Weakness

Acute cases of hyponatremia may also include:

  • Syncope
  • Seizure
  • Hallucination
  • Respiratory arrest
  • Coma
  • Death

The risk of hyponatremia also increases in the elderly population, who uses serotonergic antidepressants and those who take diuretics. 

6. Mania or Hypomania 

Mania and hypomania are common symptoms of most people with bipolar disorder. However, people without bipolar disorder may also experience these symptoms. 

According to pre-marketing clinical studies, less than 0.1 percent of patients who are under Trintellix treatment reported symptoms of mania or hypomania. The activation of these symptoms has also been reported in a small group of patients who have major affective disorders and are using other types of antidepressants as part of their treatment. 

Like any other types of antidepressants, Trintellix must be used with caution, especially in people who have a family history or a history of bipolar disorder, hypomania, or mania. 

7. Worsening Depression and Increased Suicidal Behavior

One of the long-standing concerns of using antidepressants is the emergence of suicidality and worsening depression of certain patients during early antidepressant treatment. 

Adults and children who have major depressive disorder (MDD) may still have an increased risk of worsening depression and or suicidal tendencies whether or not they are taking antidepressant medications. These risks may also persist until there is significant remission. 

People with depression and other psychiatric disorders are often at risk of developing suicidal ideation. These mental disorders are also considered as the strongest predictors of suicide.  

Other Adverse Side Effects

Based on clinical studies, other adverse reactions of Trintellix may include:

  • Ear and labyrinth disorders such as vertigo
  • Nervous system disorders such as seizures and dysgeusia (distorted sense of taste)
  • Vascular disorders such as flushing
  • Gastrointestinal disorders such as acute pancreatitis and dyspepsia
  • Metabolic disorders such as weight gain
  • Disorders of the skin and subcutaneous tissue such as a generalized rash

Abrupt Discontinuation of Trintellix Treatment

Patients who are taking Trintellix with dosages of 10 mg, 15 mg, and 20 mg per day have been evaluated for discontinuation symptoms using a scale called Discontinuation-Emergent Signs and Symptoms (DESS) in clinical trials. 

In the first seven days of abrupt discontinuation of Trintellix with dosages of 15 mg/day and 20 mg/day, there were patients who experienced the following discontinuation symptoms:

  • Mood swings
  • Headaches
  • Dizziness
  • Runny nose
  • Muscle tension
  • Sudden outbursts of anger

There should be appropriate monitoring and close observance of all patients who are under antidepressant treatment for any indication. The following symptoms must be closely monitored:

  • Suicidal tendencies
  • Worsening of depression
  • Unusual behavioral changes during the first few months of treatment or when increasing or decreasing the drug's dosage

When changing a patient's therapeutic regimen, consideration should also be given with regards to the following:

  • The possibility of discontinuing the medication
  • A persistently worsening depression
  • The emergence of suicidal ideation
  • Abrupt and severe symptoms before the occurrence of a worsening suicidality or depression
  • The onset of certain symptoms that were not initially experienced by patients

Caregivers or family members of patients who are taking antidepressant medications for major depressive disorder must be informed about the necessity of monitoring any emergence of unusual behavioral changes, irritability, agitation, and all of the above-mentioned symptoms. It is also important to report any of these changes to healthcare providers and to closely monitor patients on a daily basis. 

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