Vilazodone, marketed under the brand name Viibryd, is an antidepressant used to treat major depressive disorder (MDD). As with many powerful medications, it comes with a list of important interactions and precautions that patients must heed. Failure to do so can lead to an increased risk of severe side effects, medication ineffectiveness, or other serious health complications. The most crucial aspect of safely taking vilazodone is maintaining open communication with your healthcare provider about all substances you ingest.
Medications to Avoid or Use with Caution
Certain medications can have dangerous interactions when combined with vilazodone. These interactions are often due to an increased risk of serotonin syndrome or increased bleeding. Never start, stop, or change a medication without first consulting your doctor or pharmacist.
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs are a class of antidepressants that should never be combined with vilazodone. The combination can lead to a potentially fatal spike in serotonin levels, causing serotonin syndrome. A "washout" period is necessary when switching between these medications. You must wait at least 14 days after discontinuing an MAOI before starting vilazodone, and vice versa. Examples of MAOIs include:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Selegiline (Emsam, Zelapar)
- Linezolid (Zyvox), an antibiotic with MAOI properties
Other Serotonergic Drugs
Vilazodone increases serotonin levels in the brain, and combining it with other drugs that do the same significantly increases the risk of serotonin syndrome. If a combination is deemed necessary, your doctor will monitor you closely.
Common serotonergic medications to use with caution include:
- Other antidepressants: This includes selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
- Triptans: Migraine medications such as sumatriptan (Imitrex) and rizatriptan (Maxalt) can contribute to serotonin syndrome.
- Opioid pain medications: Tramadol is a common opioid that can raise serotonin levels.
Blood Thinners and Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Vilazodone can increase the risk of bleeding or bruising. This risk is compounded when taken with other medications that affect blood clotting.
- Blood Thinners (Anticoagulants/Antiplatelets): This category includes medications like warfarin (Coumadin), rivaroxaban (Xarelto), apixaban (Eliquis), and clopidogrel (Plavix).
- NSAIDs: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) should be used with caution, especially at high doses or for regular use. A safer alternative for occasional pain relief is acetaminophen (Tylenol).
Digoxin and Other Specific Drugs
Vilazodone can interact with other specific drugs, requiring dose adjustments or closer monitoring. For instance, vilazodone can raise digoxin levels, a heart medication, to a toxic range. Some oral antifungals, like ketoconazole and itraconazole, can increase vilazodone levels, while the antibiotic rifampin can decrease its effectiveness.
Substances and Lifestyle Factors to Avoid
Medication safety isn't limited to prescription drugs. Certain everyday substances and lifestyle choices can also negatively interact with vilazodone.
Alcohol
It is strongly recommended to avoid drinking alcohol while taking vilazodone. Alcohol can worsen common side effects like dizziness and drowsiness. It can also exacerbate depression symptoms, undermining the medication's effectiveness.
St. John's Wort and Other Herbal Supplements
St. John's Wort is an herbal supplement sometimes used to treat depression, but it should be avoided entirely. It can increase serotonin levels, significantly raising the risk of serotonin syndrome when combined with vilazodone. It can also lower vilazodone's effectiveness. Always consult your healthcare provider before taking any herbal products with vilazodone.
Grapefruit
Grapefruit and grapefruit juice can interact with vilazodone by increasing the drug's levels in your bloodstream. This can raise the risk of side effects. It is best to avoid grapefruit products while on this medication.
Caution with Driving and Operating Heavy Machinery
Vilazodone can cause drowsiness and affect judgment, particularly when you first start taking it. Do not drive or operate heavy machinery until you are certain how the medication affects you.
Comparison of Vilazodone Interactions
| Interaction Type | Examples | Potential Risk | Recommendation |
|---|---|---|---|
| Serotonergic Drugs | MAOIs, SSRIs, SNRIs, TCAs, triptans, tramadol | Serotonin Syndrome (life-threatening) | Avoid MAOIs completely. Use other serotonergic drugs with extreme caution and medical supervision. |
| Bleeding Risks | Warfarin, NSAIDs (ibuprofen, naproxen), aspirin | Increased risk of bleeding or bruising | Inform your doctor. Consider acetaminophen for pain relief instead of NSAIDs. |
| CYP3A4 Interactions | Oral antifungals (ketoconazole), antibiotics (rifampin) | Increased vilazodone levels (toxicity) or decreased levels (ineffectiveness) | Dose adjustment or alternative medications may be required. |
| Lifestyle/Diet | Alcohol, grapefruit, St. John's Wort | Worsened side effects, decreased effectiveness, serotonin syndrome risk | Avoid completely or use with extreme caution as directed by a healthcare professional. |
Conclusion
Understanding what to avoid while taking vilazodone is a critical part of a safe and effective treatment plan. The most significant risks include severe drug interactions, especially with MAOIs and other serotonergic medications, and an increased potential for bleeding. Additionally, substances like alcohol, St. John's Wort, and grapefruit can undermine the medication's effects and increase adverse reactions. Always maintain an open dialogue with your healthcare provider and pharmacist about all medications, supplements, and lifestyle choices to ensure your safety and treatment success. For more detailed information on vilazodone, consult the National Alliance on Mental Illness (NAMI) at https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Vilazodone-(Viibryd).
