Vortioxetine (Trintellix) is a drug for major depressive disorder (MDD). Just like any other medication, it can cause side effects. A few are common, like nausea or dizziness. There also are more serious, but rare, side effects.
Here’s what you can do about them and play an active role in your treatment.
How Can You Manage the Common Side Effects of Vortioxetine (Trintellix)?
The most common side effects of this drug include:
Sexual dysfunction. When you begin this drug, you might start to have issues with or during sex. You may not be able to orgasm, or you might have delayed orgasms. Some people can’t get or keep an erection. You might also notice that your sex drive, interest, and performance are also lower than usual.
Not everyone who takes vortioxetine will have problems with sex. And the effects might ease as your body gets used to the medication.
The best way to manage your symptoms is to talk honestly with your doctor. They might switch your medication or add another drug to treat your sexual dysfunction. The good news is that compared to other antidepressants, vortioxetine has relatively low rates of sexual side effects.
Nausea and vomiting. This is normally mild or moderate. It usually lasts for 2 weeks but might last longer in some people.
To relieve nausea, try to:
- Eat bland and light foods, like plain bread.
- Stay away from greasy, fried, or sweet foods.
- Drink clear or iced drinks.
- Drink and eat slowly.
- Avoid mixing hot and cold foods.
- Rest after you eat.
To treat vomiting:
- Don't eat solid food until your vomiting has stopped.
- Drink more clear liquids over time.
- Rest.
If these things don’t help your nausea or vomiting, see your doctor.
Constipation. Many people who take vortioxetine can have trouble with bowel movements. Ask your doctor about treatments for your constipation. You can try a few things to ease your discomfort, such as:
- Add more fiber to your diet (like fresh fruits, vegetables, whole-grain breads, and cereals) to help speed up movement in your intestines.
- Exercise each day to boost the muscle activity in your intestines.
- Take it slow in the bathroom. Make sure you’re relaxed and able to go without feeling rushed.
- Ask your doctor about laxatives to help you go to the bathroom.
What to Do If You Have a Serious Side Effect From Vortioxetine (Trintellix)
It’s rare, but some side effects linked to vortioxetine can be life-threatening. While these may not be as common as other symptoms, it’s important that you know what to do if they happen to you:
Serotonin syndrome. Serotonin is a natural chemical in your body, but too much can lead to mild symptoms like shivering and diarrhea, or to more serious ones like fever, seizures, or even death if you don’t get treatment. This condition happens when you take vortioxetine with other certain types of medication that have serotonergic effects, which means they could also lead to serotonin syndrome on their own. These drugs include:
- Several types of antidepressants, including SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs)
- A class of migraine medications called triptans
- Antibiotics such as Linezolid (Zyvox)
- Methylene blue, a drug for methemoglobinemia, a rare blood condition that affects how oxygen moves through your body
- Narcotics, which are medications that treat moderate to severe pain, such as fentanyl (Abstral, Duragesic, Subsys), meperidine (Demerol), pentazocine (Talwin), and tramadol (ConZip, Ultram)
- Mood stabilizers like lithium (Eskalith, Eskalith-CR, Lithobid), that treat bipolar disorder
- Antipsychotic agents, which treat hallucinations, delusions, and other symptoms of psychosis
- The over-the-counter drug dextromethorphan, which is used for coughs
- St. John's wort, a supplement
Call your doctor or go to the closest emergency room right away if you have any of these symptoms:
- Sweating
- Flushing
- Agitation
- Hallucinations (you see or hear things that aren’t really there)
- Confusion
- Hyperthermia or a high body temperature
- A fast heartbeat
- Changes in your blood pressure
- Dizziness
- Seizures
- Nausea, vomiting, or diarrhea
- A loss of coordination
- Shaking, stiff muscles, or muscle twitching
It’s unlikely, but another severe side effect to vortioxetine is coma.
Tell your doctor about all of the medications you take, including herbal remedies, vitamins, or supplements.
Discontinuation syndrome. This can happen if you stop vortioxetine suddenly. Symptoms include:
- Nausea
- Sweating
- Dizziness
- Changes in your mood
- Irritability
- Anxiety
- Headache
- Seizures
- Sleep problems
Follow your doctor’s guidance before you switch medications or adjust your dosage.
Angle-closure glaucoma. Vortioxetine might cause this vision problem in people who are at risk for it. This happens because the drug can lead to mildly dilated pupils. In people who have a genetic risk, this can lead to angle-closure glaucoma.
The symptoms of angle-closure glaucoma include:
- Pain in your eye
- Vision changes
- Swelling or redness on or around your eye
If you notice any of these signs, call your doctor.
You can get an eye exam to find if you’re at risk for angle-closure glaucoma or not. If your doctor finds that you are, you’ll be able to get preventative treatment.
Treatment will lower the pressure in your eyes. Your doctor may suggest:
- Medicine. Eye drops, pills, or an intravenous (IV) medication can help treat this condition.
- Surgery. Your doctor will make a small opening and put a tiny tube in your eye to help fluid drain better.
- Laser therapy. This will help the fluid in your eye drain.
If you do have angle-closure glaucoma and haven’t had laser therapy or surgery, you should avoid certain over-the-counter drugs, including those for colds, allergies, and motion sickness.
Hyponatremia. This is when the sodium levels in your blood drop too low. It can be very serious or even deadly. The risks are highest for elderly people and for those who take certain medications (like diuretic medications for high blood pressure) in combination with vortioxetine.
The signs of hyponatremia include:
- Trouble concentration
- Headache
- Changes in your memory
- Weakness and unsteadiness, which can cause falls
- Confusion
In severe cases, hyponatremia can cause:
- Fainting
- Seizures
- Coma
- Not breathing
- Hallucinations
Call your doctor or 911 right away if you notice any of these symptoms.
It’s important to tell your doctor about all of the medications you’re on. Drinking enough liquids also may help prevent hyponatremia. Ask your doctor if you need sports beverages with electrolytes during workouts.
Moderation is key with hydration. If your urine is pale yellow and you’re not thirsty, you probably are drinking enough.
A higher risk of bleeding. If you take other medications like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, or blood thinners with vortioxetine (Trintellix), you might boost your risk of bleeding more.
The best way to manage this is to tell your doctor about all other medications you take before or after you start vortioxetine (Trintellix).
If you do notice any abnormal bleeding or bruising, tell your doctor right away.
Manic episodes. If you take vortioxetine (Trintellix) for MDD and also have bipolar disorder, you’re at risk for manic episodes. But this is very rare. During these episodes, you might have a few different symptoms. They include:
- Racing thoughts
- A lot more energy
- Talking faster and more than normal
- Intense sleep issues
- Reckless behavior
- Grand ideas that are unusual for you
- Being overly happy or irritable
It may not be possible to prevent all manic episodes, but you can try to manage them better or stop their progression. Some actions you can take to lower your chances for manic episode include:
- Stay away from activities or places that are loud, bright, or busy. Find somewhere relaxing and peaceful to go instead.
- Avoid people who will tempt you to make bad or risky choices.
- Reschedule big life events and large purchases.
- Stick to a routine with your bedtime, wake time, mealtime, workouts, and medication schedule.
- Avoid having too many social contacts so that you don’t get too stimulated.
- Ask for help from someone you trust, especially with financial needs during a manic episode.
High risk of suicidal thoughts and actions. Vortioxetine, as well as other antidepressants, might put you at risk for suicidal thoughts and actions, especially if you’re 24 or younger. This is more common in the first few months of treatment or right around the time that your doctor changes your medication dose.
Call your doctor or get emergency help right away if you:
- Think about dying
- Feel an impulse to take risks or act dangerously
- Begin to feel that you’re angry, irritable, restless, or agitated
- Notice unusual changes in your mood or behavior
- Start to feel depressed or more depressed than usual
- Start to have trouble with your sleep
- Notice that you act more aggressive or violent
- Start to have anxiety or panic attacks
- Find that you’ve become a lot more active or started to talk a lot more than usual
To prevent these thoughts or actions, there are a few things you can do:
- Be aware of any changes in your mood, thoughts, feelings, or behavior. This is especially true if they’re sudden.
- Call your doctor as soon as possible if you notice any of these changes or if you start to feel suicidal or have suicidal actions.
- Make sure you go to all of your follow-up appointments. Feel free to make more appointments between checkups, especially if you have questions or concerns about your symptoms.
