Viibryd side effects and how to avoid them

Common Viibryd side effects include gastrointestinal symptoms and insomnia. Learn how to avoid these and when to seek help for serious side effects.

By Stephanie Melby, Pharm.D. | Nov. 16, 2021

Viibryd (brand name of vilazodone hydrochloride) is an FDA-approved medication for the treatment of major depressive disorder (MDD). Initially approved by the FDA in 2011, Viibryd can effectively reduce depression symptoms by increasing serotonin activity in the body. Serotonin is an important hormone in the body that stabilizes mood, happiness, and overall well-being. Viibryd is a unique medication because it has both selective serotonin reuptake inhibitor (SSRI) activity and serotonergic (5-HT1A) receptor partial agonist activity. As with most antidepressants, Viibryd has some possible side effects. The most common Viibryd side effects are diarrhea, nausea, vomiting, and insomnia.

The unique side effect profile of Viibryd can make it preferred over other antidepressants for some patients. This is especially useful if a patient has developed sexual/erectile dysfunction, weight gain, or increased blood pressure on an SSRI or an SNRI (serotonin-norepinephrine reuptake inhibitor). Viibryd is also a more suitable option for those who cannot tolerate an atypical second-generation antipsychotic because of weight gain, sedation, extrapyramidal symptoms, or dyslipidemia. It is important for people with MDD to determine with their doctor the best antidepressant treatment plan. While Viibryd is a great option for some people, it may not be the best fit for others. This article is going to dive into possible side effects, warnings, and interactions for Viibryd.

Common side effects of Viibryd

Here are the most common side effects of vilazodone (Viibryd):

Diarrhea
Nausea
Vomiting
Insomnia
Headache
Dry mouth
Stomach pain
Dizziness
Blurred vision
Dry eye
Sexual dysfunction
Changes in appetite

Diarrhea

One of the most common side effects of Viibryd is diarrhea and will affect about 28% of people. Most SSRIs and SNRIs can cause gastrointestinal (GI) side effects like diarrhea. Compared to SSRIs and SNRIs, Viibryd has a similar chance of causing GI upset.

Serotonin is a chemical messenger (neurotransmitter) made in the body that plays a large role in digestion. Medications that work on serotonin receptors in the body can affect the movement of food in the GI tract. As a result, Viibryd can cause diarrhea typically in the first few days or weeks of beginning treatment.

Nausea and vomiting

Other common gastrointestinal side effects of Viibryd include nausea and vomiting. Nausea will happen in about 23% of people, while vomiting is less likely, affecting about 5% of people. Similar to the adverse effect of diarrhea, nausea and vomiting can occur due to the effects serotonin has in the GI tract. Some clinical studies have determined that nausea and vomiting are the most common reasons for discontinuation of antidepressant treatment.

Insomnia

Difficulties falling or staying asleep are possible side effects of Viibryd that affect about 6% of people. On the other hand, sleep disturbances are a main symptom of depression. In the long term, all antidepressants will show improvement in sleep after achieving improvement of mood and daytime activity. However, in the short term, some may impair sleep due to the activating effects the medicine has on the body. The antidepressants with SSRI activity may worsen trouble sleeping due to activation of serotonin receptors.

SSRIs have been found to increase REM sleep latency, which measures how long it takes a person to reach their first REM sleep stage after turning the lights out. Additionally, SSRIs were found to reduce the overall time spent in the REM phase while sleeping. These effects on REM sleep are typically within the initial days/weeks of treatment and may return to baseline levels after eight weeks of treatment.

Serious side effects of Viibryd

The following are possible serious side effects of Viibryd:

Suicidal thoughts and behaviors
Serotonin syndrome
Increased risk of bleeding
Activation of mania or hypomania
Hyponatremia (abnormally low sodium levels)
Angle-closure glaucoma

How long do Viibryd side effects last?

Most of the common side effects of Viibryd are temporary while the body adjusts to the new medication. The GI side effects like diarrhea, nausea, and vomiting typically happen within the first few days or weeks of beginning Viibryd. After a few weeks of treatment, GI upset should lessen or resolve. If people experience the side effect of insomnia, they should see improvement after about eight weeks.

If any of these common side effects continue after several weeks, are bothersome, or worsen over time, patients should contact their healthcare provider to discuss their treatment. If an allergic reaction is suspected, a healthcare professional should be contacted immediately.

Viibryd contraindications and warnings

Black box warning

Viibryd has a serious warning called a black box warning. As an antidepressant, it has an increased risk of suicidal thinking and behavior in children, adolescents, and young adults for MDD and other psychiatric disorders. The black box warning for Viibryd states that people of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the healthcare team.

Withdrawal

When a person stops taking Viibryd, there is a chance of discontinuation syndrome. This means there are symptoms that occur when the body withdrawals from the medication. The symptoms of discontinuation syndrome for Viibryd include irritability, agitation, anxiety, and confusion. These withdrawal symptoms could be avoided by slowly reducing the dose to discontinuation rather than an abrupt stop.

Overdose

Clinical trials of Viibryd identified doses of 200 to 280 mg with dangerous adverse reactions including serotonin syndrome, lethargy, restlessness, hallucinations, and disorientation. If an overdose is suspected, people should call 911 or visit an emergency medical facility.

Restrictions

Viibryd is not approved in pediatric patients.
For women who are pregnant or breastfeeding, Viibryd should only be used if the potential benefits outweigh the potential risks due to limited data.
Use caution in patients with a history of seizure disorder.
Use caution in patients with bipolar disorder.
Avoid use in patients with angle-closure glaucoma or anatomically narrow angles of the eyes as Viibryd use could trigger an angle-closure attack and cause severe eye pain.

Viibryd interactions

Viibryd has several drug interactions that should be avoided to prevent dangerous side effects. The following are medications and medication classes that should be avoided:

MAOIs: Viibryd cannot be used at the same time as a class of drug called MAOI (monoamine oxidase inhibitors) or within 14 days of stopping or starting an MAOI. Examples of MAOIs are phenelzine (Nardil), selegiline (Zelapar), tranylcypromine (Parnate), and isocarboxazid (Marplan). This interaction is serious and potentially life-threatening as it can cause dangerously high levels of serotonin, known as serotonin syndrome.
Linezolid: This is an antibiotic that can lead to toxic levels of serotonin if taken with Viibryd.
Methylene blue injection: This treatment for methemoglobinemia can lead to toxic levels of serotonin if taken with Viibryd.
NSAIDs and anticoagulants: Viibryd may increase the risk of bleeding if taken with NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen, aspirin, and other medications that affect blood clotting.

How to avoid Viibryd side effects

When starting a new medication, it’s important to read the drug information provided with the prescription and talk with a pharmacist for medical advice about potential side effects.

1. Take Viibryd as directed

The typical dose of Viibryd is a 40 mg tablet taken by mouth once daily. When this medicine is started, people will usually work their way up to the treatment dose of 40 mg daily. The typical starting dose is 10 mg daily for seven days, followed by 20 mg once daily for an additional seven days, and then increase to 40 mg once daily. Viibryd is available as a Starter Kit that includes the 10 mg, 20 mg, and 40 mg doses for starting therapy. Starting on a lower dose and gradually increasing the dose can help to lessen side effects.

If a dose is missed, it’s important to take the missed dose as soon as it’s remembered. However, if the time is close to the next dose, skip the missed dose and return to the normal dosing time. Do not take two doses at the same time or extra doses.

2. Take Viibryd with food

Some medications, like Viibryd, must be taken with food to make sure the medicine works properly. Taking Viibryd with food can help make sure the dose is effective.

3. Read the black box warning

It’s important for people and their family members or close friends to understand the black box warning associated with Viibryd. People should be aware of and closely monitor for warning signs of suicidal thoughts and behaviors. The National Suicide Prevention Lifeline is available 24/7 via a toll-free hotline: 1-800-273-8255.

4. Tell the doctor about all medications being taken

Some medications, like MAOIs, can cause dangerous drug interactions if taken with Viibryd. MAOIs should not be used with Viibryd or within 14 days of stopping or starting an MAOI. Viibryd may increase the risk of bleeding if taken with NSAIDs (like ibuprofen or naproxen), aspirin, warfarin, and other medications that affect blood clotting. It’s important that a healthcare professional is aware of all medications, including over-the-counter medications and supplements, being taken by patients starting new medications.

5. Do not abruptly stop taking Viibryd

If patients want to stop taking Viibryd because of side effects or they think the medication is not helping their depression, their healthcare providers should be consulted. Abruptly stopping Viibryd can lead to discontinuation syndrome. Symptoms include irritability, agitation, anxiety, and confusion. If Viibryd needs to be stopped, patients should work with their healthcare providers to slowly reduce the dose to discontinuation.

6. Tell the doctor about all medical conditions

To avoid potentially serious side effects with Viibryd, tell the prescribing healthcare provider about all medical conditions. This is especially important for patients with a history of seizures, bipolar disorder, or abnormal bleeding. It’s important that a healthcare professional is aware of all medical conditions a patient has before starting new medications.

7. Keep all doctor appointments after starting Viibryd

Like most antidepressants, Viibryd takes several weeks to work in the body. Most people will notice improvements in their depression symptoms after two to six weeks, while the maximum benefit may take six to 12 weeks. Over the initial few weeks of starting Viibryd, people may have gradual dose increases to the treatment dose so it’s important that people are aware of the dose they should be taking. Communication with the healthcare team is also important to discuss any ongoing side effects, the patient’s mental health, and determine if the medication is effective for the patient.

8. Lessen gastrointestinal side effects

Viibryd may cause diarrhea, nausea, and/or vomiting side effects. If these side effects happen, they will most likely happen in the first few days or weeks. Viibryd should be taken with food to help with absorption—and taking the dose with food can also help to prevent stomach upset. Additionally, the dose can be taken as close to bedtime as possible. This way people can rest in bed and fall asleep before any nausea develops.

9. Manage the side effect of insomnia

Viibryd may cause trouble sleeping when it is first started. This can lead to daytime tiredness and some reports of abnormal dreams. Typically, insomnia will resolve, and sleep should improve in patients after several weeks. In the meantime, people can practice good sleep hygiene habits. Some good sleep hygiene practices include setting a sleep schedule with a fixed wake-up time, following a nightly routine, and ensuring a healthy lifestyle (some examples include cutting down on afternoon/evening caffeine, being physically active, reducing alcohol consumption, and not eating dinner late).