Vilazodone (Viibryd): dosage, uses, side effects

If you're struggling with symptoms of depression, you're not alone. A 2019 study found that almost 8% of adults in the United States experienced a major depressive episode within the previous year (NIMH, 2021). Luckily, effective treatment is available. Find out how one anti-depressant called Viibryd helps improve depression symptoms and if it could be an option for you. 

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Vilazodone (brand name Viibryd) is a prescription medication used to treat depression. Viibryd belongs to a group of antidepressants called serotonin modulators, which work by affecting serotonin levels and activity in the brain. Serotonin is a neurotransmitter—a chemical messenger that delivers signals from one part of the body to another. Researchers believe that low levels of serotonin contribute to depression. Viibryd helps correct this imbalance by increasing serotonin levels and activating serotonin receptors (Sahli, 2016). 

Viibryd is approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD). Like other antidepressant medications, Viibryd takes time to work. You may notice an improvement in your symptoms within two weeks of starting Viibryd, but it can take up to eight weeks to get the full benefits (Sahli, 2016).

The most common side effects of Viibryd are diarrhea and nausea. These effects often occur when you first start Viibryd and tend to go away on their own after 4–5 days (Sahli, 2016). Let your healthcare provider know if your symptoms don’t improve. 

 Other common adverse effects include (Hafeez, 2019):

• Dizziness 

• Dry mouth 

• Tiredness 

• Trouble sleeping 

• Vomiting 

Rarely, Viibryd may cause serious side effects. Certain conditions may increase your risk. Be sure to review the warnings associated with Viibryd (see below) and report any signs of a serious reaction to your healthcare provider. 

Viibryd is available in 10 mg, 20 mg, and 40 mg tablets. The typical starting dose is 10 mg daily. Your healthcare provider may increase your dose to a maximum of 40 mg daily, depending on your symptoms and side effects (Allergan, 2021). 

Be sure to take your dose of Viibryd at the same time each day with food. Food helps your body absorb Viibryd. Without food, Viibryd levels will be too low and can limit how well the drug works (Allergan, 2021).

Viibryd is associated with several potentially serious warnings. Be sure to review these warnings and discuss any concerns you have with your healthcare provider. 

Suicidal thoughts and behaviors 

All antidepressants, including Viibryd, are associated with an increased risk of suicidal thoughts and behaviors in children and young adults. Clinical studies have not shown an increased risk in people over the age of 24. Still, the FDA recommends family members and caregivers monitor all people started on Viibryd for worsening symptoms, especially during the first few months of treatment. Untreated depression is also a risk for suicidal tendencies, so you and your healthcare provider must weigh the risks of starting or withholding treatment with Viibryd (Allergan, 2021). 

Serotonin syndrome 

Rarely, Viibryd may cause serotonin levels in the brain to become too high and lead to a serious condition called serotonin syndrome. Taking Viibryd with other medications that also affect serotonin levels (e.g., other antidepressants or certain pain medicines) increases your risk of this condition. If left untreated, the symptoms of serotonin syndrome can progress quickly and become life-threatening. Seek medical care right away if you develop any of the following while taking Viibryd (Allergan, 2021):

• Agitation or restlessness 

• Changes in blood pressure 

• Confusion 

• Diarrhea 

• Dizziness 

• Fast heartbeat 

• Fever 

• Flushing 

• Hallucinations 

• Muscle stiffness or muscle spasms 

• Nausea or vomiting 

• Nervousness 

• Seizures 

• Sweating 

• Tremor 

• Trouble sleeping 

• Trouble with balance or coordination 

Discontinuation syndrome 

Withdrawal symptoms can occur if you stop taking Viibryd, especially if you stop suddenly. Symptoms can sometimes be serious, so talk with your healthcare provider if you’re interested in stopping Viibryd. They’ll likely recommend slowly reducing your dose to help limit reactions. Withdrawal symptoms include (Allergan, 2021):

• Anxiety 

• Abrupt or severe changes in your mood 

• Confusion 

• Dizziness

• Electric shock sensations 

• Headaches

• Irritability and agitation 

• Nausea

• Problems sleeping 

• Ringing in your ears

• Seizures 

• Sweating 

• Tiredness 

Sexual dysfunction 

Viibryd may cause sexual problems in both men and women, including decreased sex drive, delayed orgasm, inability to achieve orgasm, and trouble getting or maintaining an erection. Don’t hesitate to let your healthcare provider know if you’re experiencing sexual difficulties—treatment options may be available (Allergan, 2021). 

Bleeding risk

Viibryd may increase your risk of bleeding, including bruising, nosebleeds, and bleeding in the stomach. Taking Viibryd with aspirin, NSAIDs (like naproxen or ibuprofen), warfarin, or other blood thinners increases the risk. Let your healthcare provider know if you notice any unusual bleeding (Allergan, 2021). 

Mania or hypomania (manic episodes)

Viibryd can cause manic episodes in people with a history of bipolar disorder. Symptoms include increased energy levels, racing thoughts, talking more or faster than normal, trouble sleeping, and excessive happiness or irritability. Let your healthcare provider know if you’ve ever been diagnosed with bipolar disorder (Allergan, 2021). 

Seizures

Viibryd may increase the risk of seizures, so be sure to let your healthcare provider know if you've had seizures in the past (Allergan, 2021). 

Low sodium levels

Viibryd can cause sodium levels in your blood to become too low, especially if you are older or take certain diuretic medications (sometimes called “water pills”). Signs of low sodium include headache, difficulty concentrating, confusion, and weakness. Very low sodium levels can sometimes be life-threatening and cause severe symptoms, including hallucinations, seizures, fainting, and coma. Seek medical care if you develop any signs of low sodium (Allergan, 2021). 

Glaucoma

Viibryd can cause an eye problem called angle-closure glaucoma, especially in people with certain untreated eye conditions. Let your healthcare provider know if you develop eye pain or any changes in your vision (Allergan, 2021). 

Pregnancy and breastfeeding 

Taking Viibryd late in pregnancy increases the risk that your baby may develop certain problems after delivery. If you are pregnant or plan to become pregnant, discuss these risks with your healthcare provider before starting Viibryd. 

It is unknown if Viibryd transfers into breast milk or what effects breastfeeding could have on your baby. Talk with your healthcare provider about the best way to feed your baby while taking Viibryd (Allergan, 2021). 

Many drugs may interact with Viibryd. Always keep an updated list of all the medicines you take, including over-the-counter natural products and supplements, and let your doctor know any time there are changes. Watch out for these common drug interactions:

MAOIs (monoamine oxidase inhibitors) must never be taken with Viibryd due to the increased risk of serotonin syndrome. Don’t start Viibryd within 14 days of stopping an MAOI, and don’t start an MAOI within 14 days of stopping Viibryd (Allergan, 2021). MAOIs include:

• Isocarboxazid (Marplan) 

• Linezolid (Zyvox)

• Phenelzine (Nardil) 

• Rasagiline (Azilect) 

• Selegiline (Emsam, Zelapar) 

• Tranylcypromine (Parnate) 

• Intravenous (IV) methylene blue 

Other medications also increase your risk of developing serotonin syndrome. Let your healthcare provider know if you take (Foong, 2018):

• SNRIs (serotonin-norepinephrine reuptake inhibitors) like duloxetine (Cymbalta) and venlafaxine (Effexor XR) 

• SSRIs (selective serotonin reuptake inhibitors), such as paroxetine (Paxil, Brisdelle), fluoxetine (Prozac), escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft)

• TCAs (tricyclic antidepressants) like clomipramine (Anafranil) and imipramine 

• Cough and cold products that contain dextromethorphan (“DM”) and chlorpheniramine 

• Natural health supplements like St. John’s wort, L-tryptophan, and diet pills 

• Drugs of abuse, such as ecstasy (MDMA), amphetamine, and cocaine 

The following medications can increase the risk of bleeding with Viibryd (Allergan, 2021): 

• Aspirin 

• NSAIDs like ibuprofen or naproxen 

• Blood thinners like warfarin, apixaban (Eliquis), or rivaroxaban (Xarelto)

• Antiplatelet drugs like clopidogrel (Plavix) or ticagrelor (Brilinta) 

Certain drugs can increase Viibryd levels. Your healthcare provider may limit your dose of Viibryd if you take (Allergan, 2021): 

• Certain HIV medications 

• Clarithromycin 

• Antifungal medications like ketoconazole, voriconazole, or itraconazole 

This is not a complete list of all the drugs that may interact with Viibryd. Always check with your healthcare provider or pharmacist before starting anything new. If you're struggling with depression, finding the motivation to seek help can be hard. But sharing your concerns with your healthcare provider is the first step to getting you well. Your doctor may recommend Viibryd as part of your treatment plan to get you feeling your best and back to doing the things you love. 

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Current version

November 08, 2021

Written by

Christina Varvatsis, PharmD

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.