Vilazodone (Viibryd) Patient Guide: Benefits, Dosing, and Side Effects Explained

This guide is adapted from the clinician guide authored by Sebastián Malleza, M.D., M.Sc. at the Psychopharmacology Institute. For the complete clinical resource, visit: Vilazodone Guide: Pharmacology, Indications, Dosing Guidelines and Adverse Effects

What is Vilazodone?

Vilazodone (brand name Viibryd) is a medication approved for treating major depressive disorder (MDD) in adults.[3,10] It belongs to a class of antidepressants called SPARIs (Serotonin Partial Agonist/Reuptake Inhibitors), which work differently from traditional SSRIs [1,2]

The latest clinical guidelines (CANMAT 2024) list vilazodone as a first-line antidepressant option for depression [10]

Compared to other antidepressants, vilazodone may offer these advantages:

• Generally weight-neutral (minimal weight changes in clinical studies)[6,17,18]
• May have lower rates of sexual side effects compared to some SSRIs (though evidence is still inconclusive [2]
• May be helpful for depression with prominent anxiety symptoms [7]

Your doctor might recommend alternatives if you:

• Cannot reliably take medication with food (vilazodone must be taken with food for proper absorption)[3]
• Are pregnant or breastfeeding (limited safety data available)[3,23]
• Are looking for a faster-acting antidepressant (vilazodone has not been proven to work faster than other antidepressants)[2]

How Does This Medication Work?

Vilazodone works through two main mechanisms: [1,2]

1. Serotonin reuptake inhibition: Like traditional SSRIs, it increases serotonin levels in the brain by blocking its reabsorption.
2. 5-HT1A partial agonism: It also directly activates specific serotonin receptors (5-HT1A receptors), which may provide additional benefits.

This “dual mechanism” is sometimes called multimodal action [1,2]. However, despite theoretical advantages, clinical studies have not consistently shown vilazodone to be superior to standard antidepressants[2].

Vilazodone has minimal effects on other brain chemicals like norepinephrine and dopamine [3].

How to Take This Medication

Vilazodone comes as immediate-release tablets in 10 mg, 20 mg, and 40 mg strengths[3]. A starter pack is available that contains 10 mg and 20 mg tablets for initial titration.

Always take vilazodone with food. Taking it without food reduces absorption by approximately 50%, which may result in the medication not working properly[3].

Typical dosing schedule:

• Starting dose: 10 mg once daily with food for 7 days[3]
• Week 2: Increase to 20 mg once daily with food
• Week 3 and beyond: May increase to 40 mg once daily with food if needed[3]
• Target dose: 20 mg to 40 mg once daily
• Maximum dose: 40 mg/day

This gradual increase helps minimize gastrointestinal side effects[3].

Important instructions:

• Take it at approximately the same time each day
• Can be taken morning or evening, though some patients prefer morning dosing if it causes difficulty sleeping
• Tablets can be split if needed for dose adjustment
• If you miss a dose, take it as soon as you remember with food. If it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses to make up for a missed one.

Common Side Effects

Many side effects improve over time as your body adjusts to the medication.

Digestive system effects:

• Diarrhea (26-29% incidence)[3,17]
  • Most common gastrointestinal side effect
  • Usually transient and improves with continued treatment
• Nausea (22-24% incidence)[3]
  • Most common reason for stopping the medication (1.4%)[3]
  • Generally occurs in the first 1-2 weeks of treatment
  • Dose-related effect
  • Can be minimized by taking with food as recommended
• Dry mouth (7-8% incidence)[3]
• Vomiting (4-5% incidence)[3]

Neurological/psychiatric effects:

• Headache (14-15% incidence)[3]
• Insomnia (6-7% incidence)[3]
  • May be managed by morning dosing
  • Consider dose reduction or slower titration if persistent
• Dizziness (6-8% incidence)[3]
• Somnolence/drowsiness (4-5% incidence)[3]
• Abnormal dreams (2-3% incidence)[3]
• Paresthesia/tingling (2% incidence)[3]

Sexual side effects:

• Claims of lower risk compared with SSRIs remain unproven; results in studies were inconsistent[2]
• In patients without baseline sexual problems, incidence was relatively low (~8%)[2]
• Males: Erectile dysfunction (3%), decreased libido (3-4%), abnormal orgasm (2%), ejaculatory disorder (2%)[3]
• Females: Decreased libido (2%), abnormal orgasm (1%)[3]

Weight changes:

• Generally weight-neutral in clinical studies[6,18]
• Short-term trials showed minimal weight changes (0.2-0.4 kg)[17,18]
• Long-term (52-week): Average increase of 1.7 kg[19]

Important Safety Information

Do Not Take Vilazodone If:

• You are taking or have recently taken (within 14 days) medications called MAOIs (monoamine oxidase inhibitors)[3]
• This includes MAOIs for psychiatric use (phenelzine, tranylcypromine) as well as the antibiotic linezolid and intravenous methylene blue

Talk to Your Doctor Before Taking Vilazodone If You:

• Take other medications that affect serotonin (other antidepressants, triptans, tramadol)[3]
• Take medications that affect CYP3A4 enzymes (ketoconazole, clarithromycin, carbamazepine, phenytoin, rifampin)[3]
• Take blood thinners, aspirin, or NSAIDs (ibuprofen, naproxen)[2,3,9]
• Take digoxin (a heart medication)[3]
• Have bleeding problems[2,9]
• Have a history of bipolar disorder[3]
• Have narrow-angle glaucoma[3]
• Are elderly or take diuretics (increased risk of low sodium)[3]
• Are pregnant, planning pregnancy, or breastfeeding[3,22,23]

Dose Adjustments for Drug Interactions:

• With strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin): Maximum dose is 20 mg/day[3]
• With strong CYP3A4 inducers (carbamazepine, phenytoin, rifampin) for more than 14 days: Your doctor may increase the dose up to 80 mg/day[3]

When to Contact Your Doctor Immediately

Contact your healthcare provider right away if you experience:

• Unusual changes in behavior, thoughts of suicide, or worsening depression[3]
• Signs of serotonin syndrome: agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, muscle stiffness or twitching, trouble with coordination, nausea, vomiting, or diarrhea[3]
• Severe abdominal pain with nausea or vomiting (may indicate pancreatitis)[3,20]
• Unusual bleeding or bruising[2,9]
• Signs of low sodium: headache, difficulty concentrating, memory problems, confusion, weakness, unsteadiness[3,21]
• Signs of mania: decreased need for sleep, racing thoughts, reckless behavior, feeling unusually energetic[3]
• Eye pain, vision changes, or eye redness/swelling (may indicate angle-closure glaucoma)[3]
• Severe allergic reaction: rash, itching, swelling, severe dizziness, trouble breathing

Starting and Stopping the Medication

Starting: It may take several weeks before you notice the full benefits of this medication.

If treatment doesn’t seem to be working: Make sure you are taking the medication with food (taking it without food reduces effectiveness by ~50%). Your doctor may also check for drug interactions.[3]

Stopping: Do not stop taking vilazodone suddenly without talking to your doctor. Although discontinuation symptoms are less common with vilazodone compared to some other antidepressants, a gradual taper is still recommended:[2,3,8]

• From 40 mg/day: Taper to 20 mg/day for 4 days, then 10 mg/day for 3 days before stopping[3]
• From 20 mg/day: Taper to 10 mg/day for 7 days before stopping[3]

Possible discontinuation symptoms include:

• Dizziness
• Nausea
• Headache
• Irritability
• Insomnia

Special Considerations

Pregnancy and Breastfeeding

• Limited human data available on vilazodone during pregnancy[3,22]
• Animal studies showed no birth defects at doses up to 10 times the maximum human dose[3,22]
• One case report described a healthy infant after maternal use throughout pregnancy[23]
• Late pregnancy exposure to serotonergic antidepressants may be associated with neonatal adaptation syndrome and possibly persistent pulmonary hypertension of the newborn[3,24-28]
• No data on presence in human breast milk, though it is excreted in rat milk[3]
• Breastfed infants should be monitored for sedation, poor feeding, and adequate weight gain[23]
• Talk to your doctor about the risks and benefits if you are pregnant or breastfeeding

Older Adults

• No dose adjustment needed[3]
• Your doctor may monitor you more closely for side effects like low sodium levels[3]

Kidney or Liver Problems

• No dose adjustment needed for mild to severe kidney or liver problems[3]

References

1. Schwartz, T. L., Siddiqui, U. A., & Stahl, S. M. (2011). Vilazodone: A brief pharmacological and clinical review of the novel serotonin partial agonist and reuptake inhibitor. Therapeutic Advances in Psychopharmacology, 1(3), 81–87.
2. Chauhan, M., Parry, R., & Bobo, W. V. (2022). Vilazodone for Major Depression in Adults: Pharmacological Profile and an Updated Review for Clinical Practice. Neuropsychiatric Disease and Treatment, 18, 1175–1193.
3. Food & Drug Administration. (2023). VIIBRYD® (vilazodone hydrochloride) tablets, for oral use prescribing information.
4. Sahli, Z. T., Banerjee, P., & Tarazi, F. I. (2016). The Preclinical and Clinical Effects of Vilazodone for the Treatment of Major Depressive Disorder. Expert Opinion on Drug Discovery, 11(5), 515–523.
5. Wagner, G., Schultes, M.-T., Titscher, V., Teufer, B., Klerings, I., & Gartlehner, G. (2018). Efficacy and safety of levomilnacipran, vilazodone and vortioxetine compared with other second-generation antidepressants for major depressive disorder in adults: A systematic review and network meta-analysis. Journal of Affective Disorders, 228, 1–12.
6. Mathews, M., Gommoll, C., Chen, D., Nunez, R., & Khan, A. (2015). Efficacy and safety of vilazodone 20 and 40mg in major depressive disorder: A randomized, double-blind, placebo-controlled trial. International Clinical Psychopharmacology, 30(2), 67–74.
7. Thase, M. E., Chen, D., Edwards, J., & Ruth, A. (2014). Efficacy of vilazodone on anxiety symptoms in patients with major depressive disorder. International Clinical Psychopharmacology, 29(6), 351–356.
8. Laughren, T. P., Gobburu, J., Temple, R. J., et al. (2011). Vilazodone: Clinical basis for the US Food and Drug Administration’s approval of a new antidepressant. The Journal of Clinical Psychiatry, 72(9), 1166–1173.
9. Bixby, A. L., VandenBerg, A., & Bostwick, J. R. (2019). Clinical Management of Bleeding Risk With Antidepressants. Annals of Pharmacotherapy, 53(2), 186–194.
10. Lam, R. W., Kennedy, S. H., Adams, C., et al. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults. Can. J. Psychiatry, 69(9), 641–687.
11. Gommoll, C., Forero, G., Mathews, M., et al. (2015). Vilazodone in patients with generalized anxiety disorder: A double-blind, randomized, placebo-controlled, flexible-dose study. International Clinical Psychopharmacology, 30(6), 297–306.
12. Gommoll, C., Durgam, S., Mathews, M., et al. (2015). A double-blind, randomized, placebo-controlled, fixed-dose phase III study of vilazodone in patients with generalized anxiety disorder. Depression and Anxiety, 32(6), 451–459.
13. Durgam, S., Gommoll, C., Forero, G., et al. (2016). Efficacy and Safety of Vilazodone in Patients With Generalized Anxiety Disorder: A Randomized, Double-Blind, Placebo-Controlled, Flexible-Dose Trial. The Journal of Clinical Psychiatry, 77(12), 1687–1694.
14. Zareifopoulos, N., & Dylja, I. (2017). Efficacy and tolerability of vilazodone for the acute treatment of generalized anxiety disorder: A meta-analysis. Asian Journal of Psychiatry, 26, 115–122.
15. Careri, J. M., Draine, A. E., Hanover, R., & Liebowitz, M. R. (2015). A 12-Week Double-Blind, Placebo-Controlled, Flexible-Dose Trial of Vilazodone in Generalized Social Anxiety Disorder. The Primary Care Companion for CNS Disorders, 17(6), 10.4088/PCC.15m01831.
16. Kayser, R. R. (2020). Pharmacotherapy for Treatment-Resistant Obsessive-Compulsive Disorder. The Journal of Clinical Psychiatry, 81(5), 19ac13182.
17. Khan, A., Cutler, A. J., Kajdasz, D. K., et al. (2011). A randomized, double-blind, placebo-controlled, 8-week study of vilazodone, a serotonergic agent for the treatment of major depressive disorder. The Journal of Clinical Psychiatry, 72(4), 441–447.
18. Croft, H. A., Pomara, N., Gommoll, C., Chen, D., Nunez, R., & Mathews, M. (2014). Efficacy and safety of vilazodone in major depressive disorder: A randomized, double-blind, placebo-controlled trial. The Journal of Clinical Psychiatry, 75(11), e1291–1298.
19. Robinson, D. S., Kajdasz, D. K., Gallipoli, S., Whalen, H., Wamil, A., & Reed, C. R. (2011). A 1-year, open-label study assessing the safety and tolerability of vilazodone in patients with major depressive disorder. Journal of Clinical Psychopharmacology, 31(5), 643–646.
20. Food & Drug Administration. (2016). VIIBRYD® (vilazodone hydrochloride) tablets, for oral use SUPPLEMENT APPROVAL.
21. Das, S., & Thirthalli, J. (2019). Dose dependent hyponatremia caused by Vilazodone: A case report. Asian Journal of Psychiatry, 43, 213.
22. Agrawal, P., Singh, P., & Singh, K. P. (2024). Vilazodone exposure during pregnancy: Effects on embryo-fetal development, pregnancy outcomes and fetal neurotoxicity by BDNF/Bax-Bcl2/5-HT mediated mechanisms. Neurotoxicology, 105, 280–292.
23. Morrison, C. M. (2014). A Case Report of the Use of Vilazodone in Pregnancy. The Primary Care Companion for CNS Disorders, 16(2), PCC.13l01612.
24. Chambers, C. D., Hernandez-Diaz, S., Van Marter, L. J., et al. (2006). Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. The New England Journal of Medicine, 354(6), 579–587.
25. Andrade, S. E., McPhillips, H., Loren, D., et al. (2009). Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiology and Drug Safety, 18(3), 246–252.
26. Källén, B., & Olausson, P. O. (2008). Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiology and Drug Safety, 17(8), 801–806.
27. Wichman, C. L., Moore, K. M., Lang, T. R., et al. (2009). Congenital Heart Disease Associated With Selective Serotonin Reuptake Inhibitor Use During Pregnancy. Mayo Clinic Proceedings, 84(1), 23–27.
28. Kieler, H., Artama, M., Engeland, A., et al. (2012). Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: Population based cohort study from the five Nordic countries. BMJ (Clinical Research Ed.), 344, d8012.
29. Research, C. for D. E. and. (2019). FDA Drug Safety Communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. FDA.

---

Disclaimer: This information is not a substitute for professional medical advice. Always consult with your healthcare provider regarding your specific medical condition and treatment options.