Copyright 2012. No part of this web site may be reproduced for commercial gain. This web site is for informational purposes only and is not intended to treat, prevent or cure disease. Viibryd Vilazodone HCI 10 mg, 20 mg and 40 mg tablets. VIIBRYD DISCONTINUATION GUIDE DISCONTINUATION OF TREATMENT WITH VIIBRYD: A gradual reduction in dose is recommended rather than an abrupt cessation. WARNING:  SUICIDALITY AND ANTIDEPRESSANT DRUGS  See full prescribing information for complete boxed warning. Increased risk of suicidal thinking and behavior may become present with rapid a reduction of Viibryd. A GRADUAL REDUCTION OF VIIBRYD IS RECOMMENDED. DOSAGE FORMS AND STRENGTHS   VIIBRYD is available as 10 mg, 20 mg and 40 mg tablets.  DISCONTINUING DOSAGE When discontinuing treatment, reduce the dose gradually. Reduce Viibryd as close to a 10% reduction as possible. If a 10% reduction is not possible reduce as near to 10% as possible. Only reduce Viibryd every 14 days. Only continue the reduction of Viibryd when patient is feeling stable and discontinuation side effects are at a minimum. Example: If 20 mg of Viibryd is taken daily reduce the Viibryd dosage by as close as possible to 2 mg. This would be accomplished by taking (1) 10 mg tablet and slicing the another 10 mg in ¼’s by using a pill cutter found at most pharmacy’s. Cutting the second 10 mg tablet in 1/4 and removing one of the ¼ slices, would give the patient a 2.5 mg reduction, or just slightly higher than the recommended 10% reduction. A liquid titration method can also be employed for a more precise reduction. Check with your local pharmacy for the correct type of beaker to use and how to pour off the 10% reduction. WARNINGS AND PRECAUTIONS DURING VIIBRYD DISCONTINUATION  Clinical  Worsening/Suicide  Risk:  Monitor patients for clinical  worsening  and  suicidal  thinking or behavior during discontinuation of Viibryd. Seizures: Can occur during discontinuation. Consider a 5% withdrawal reduction in patients with a seizure disorder.  Activation  of  Mania/Hypomania:    Can  occur with treatment and during discontinuation. Insomnia: Insomnia is a common adverse reaction to Viibryd. Insomnia may occur during treatment as well as during discontinuation. Use of a natural fast acting sleep aid is recommended. Avoid the use of narcotics and other addictive medications.  A natural and fast acting sleep aid would be one comparable to Body Calm Supreme With Melatonin or Body Calm Supreme Melatonin Free manufactured by Neuro Genetic Solutions. Click here for more details. Head Symptoms: Symptoms of the head are common during Viibryd discontinuation. Dizziness, a swirling sensation and an electrical jolt “brain zaps” will be the most common Viibryd discontinuation ADR. Patients should take 3,000 mg of fish oil in the morning and 3,000 mg of fish oil at noon for relief. Distilled high quality fish oil should be used to avoid potential heavy metal toxicity. Have patient select a high EPA rated omega 3 TG with at least 400 mg EPA per softgel.  Click here for more details. Omega 3 fish oil requires vitamin e for absorption. Patient will become vitamin e deficient of supplemental vitamin e is not used. Patient should supplement with 200 to 400 i.u. daily with a mixed tocopherol.   Nausea: Discontinuation of Viibryd as well as other antidepressants may cause nausea. Patient should drink 1 to 2 cups of ginger tea daily while nausea is present. Report ALL SUSPECTED ADVERSE REACTIONS DURING DISCONTINUATION, contact  www.fda.gov/medwatch. DRUG INTERACTIONS DURING DISCONTINUATION Viibryd is metabolized extensively through the CYP3A4. Concomitant use of Viibryd with an inducer or inhibitor of CYP3A4 will need to be taken into account during discontinuation. Other inhibitor drugs, when taken concomitantly with Viibryd, may create reduced half=life and faster clearance when Viibryd is reduced. This effect will place patient in withdrawal on the other inhibitor drug and if an inducer is also being used, a complete saturation of CYP3A4 is possible and will cause overdose in patient. If patient is taking any other medication that is an inducer or inhibitor of CYP3A4 the Viibryd should only be reduced by 5% every 14 days. REASON FOR DISCONTINUATION OF VIIBRYD During Viibryd clinical studies 7.1% of patients discontinued Viibryd due to ADR’s. Your patient population should hold true to this percentage. If your patients have any of the ADR’s below, they may be the cause of discontinuation. Most patients do not inform their physician before discontinuing an antidepressant. Look for these ADR signs, talk with your patient and have them agree to keep you informed of their decision to discontinue Viibryd.