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Canadian Med Center

Understanding and Managing Trintellix Side Effects

Friday 22 March 2024
7 minute(s) read

Table of Contents

I. Common Trintellix Side Effects

II. Serious Trintellix Side Effects

III. Serious Bleeding

IV. Low Sodium Levels

V. Suicidal Thoughts

VI. Trintellix Drug Interactions

VII. Trintellix Withdrawal

VIII. Trintellix During Pregnancy

IX. Conclusion

Trintellix, also known by its generic name vortioxetine, is an antidepressant used to treat major depressive disorder in adults. [1]

While Trintellix can be an effective treatment for depression, it's important to understand that, like any medication, it may cause side effects.

This article will help you understand and manage the side effects of Trintellix, as well as other important aspects such as drug interactions, withdrawal, and its use during pregnancy.

Common Trintellix Side Effects

Starting a new medication like Trintellix can be an adjustment. While your body gets used to the drug, you may experience some temporary side effects. As your system adapts, these usually go away within a few days or weeks. However, if any side effects linger longer or become severe, contact your doctor immediately. [1]

Here’s how to manage common side effects of Trintellix:

  • Constipation: Incorporate whole grains, bran cereal, prunes, and generous servings of fruits and vegetables into your diet. Drink plenty of water to stay hydrated.
  • Diarrhea: Let your doctor know if this occurs. They may adjust your dosage or switch you to a different medication that's a better fit.
  • Dry mouth: Drink lots of water throughout the day and chew sugarless gum to stimulate saliva production. Brushing and flossing frequently also helps.
  • Nausea: Taking Trintellix with a full meal can help minimize nausea. For most people, nausea improves over the first few weeks.
  • Dizziness: Rise slowly from sitting or lying down and stay well hydrated.
  • Itching: If you experience itching, it's important to inform your doctor. They can recommend ways to treat this side effect or suggest alternative antidepressants.
  • Mild allergic reaction: Call your doctor immediately if this happens so they can advise if you should continue Trintellix. Seek emergency care immediately for serious allergic reaction symptoms like trouble breathing, throat tightness, or lips, tongue, or face swelling. [1] [2]

Serious Trintellix Side Effects

a woman sitting on a sofa feeling unwell

When beginning treatment with Trintellix, some side effects are expected as your body adjusts to the medication. Many of these are mild and will fade over time. However, there are a few more serious side effects to watch for.

If you notice any of the following, contact your doctor right away:

  • Serotonin syndrome
  • Serious bleeding
  • Low sodium levels
  • Suicidal thoughts [1]

Serotonin Syndrome

When taking Trintellix, it's important to be aware of the risk of serotonin syndrome. This is a condition that can occur when there is too much serotonin building up in your body. [3]

Trintellix works by increasing serotonin levels in the brain, which can be helpful for depression. However, sometimes this serotonin boost can become too high. This is especially likely if you are also taking other medications or supplements that raise serotonin, like other antidepressants, ADHD stimulants, or St. John's Wort. But even Trintellix alone can potentially lead to too much serotonin in some cases. [3]

Symptoms of serotonin syndrome can range from mild to severe. Milder symptoms include:

  • Agitation
  • Anxiety
  • Restlessness
  • Disorientation
  • Increases sweating
  • Fast heartbeat
  • Nausea
  • Vomiting
  • Muscle tremors or rigidity [3]

Symptoms of severe serotonin syndrome include:

  • Seizures
  • Irregular heartbeat
  • Unconsciousness [4]

Serious Bleeding

While taking Trintellix, some people may experience increased bleeding. In most cases, this bleeding is minor, such as a nosebleed. However, more serious internal bleeding is possible in rare cases. [1]

Trintellix increases the risk of bleeding when combined with certain other medications that also increase bleeding risk. These include aspirin, NSAIDs like ibuprofen, and blood thinners like warfarin. Using Trintellix with these types of drugs may compound the bleeding risk. [1]

It's important to watch for signs of serious bleeding while taking Trintellix. Symptoms to look out for include:

  • Hard-to-stop bleeding
  • Pink, red, or brown urine
  • Red or black stool
  • Coughing up blood
  • Vomiting what looks like coffee grounds [1]

Low Sodium Levels

Low sodium levels, also known as hyponatremia, can occasionally occur in those taking Trintellix. Research has found that fluid buildup caused by a condition called syndrome of inappropriate antidiuretic hormone (SIADH) is the culprit in many cases. [1]

With SIADH, the brain's hypothalamus region makes too much antidiuretic hormone, which regulates the body's fluid balance. Excess antidiuretic hormone leads to increased water retention and diluted sodium levels. [5]

Certain groups have a higher risk of low sodium with Trintellix use, including adults over 65 and those taking diuretic medications. [1]

Mild symptoms of hyponatremia can include

  • Nausea
  • Vomiting
  • Fatigue
  • Headache
  • Muscle cramps [5]

Symptoms of severely low sodium levels include:

  • Disorientation
  • Agitation
  • Coma
  • Seizures [5]

Suicidal Thoughts

The FDA has given Trintellix a black box warning due to increased risks of suicidal thoughts and behaviors in children and young adults taking the medication. A black box warning is the most serious type of warning from the FDA, signaling significant risks that patients and doctors must be aware of. [1]

If you or a loved one are taking Trintellix, it's essential to monitor for any worsening of depressive thoughts or the emergence of suicidal thinking. Contact your doctor immediately if these symptoms arise so they can adjust treatment as needed. While on this medication, be on the lookout for changes in mood and thinking that could lead to suicidal behaviors. Stay vigilant and report any concerns immediately.

Trintellix Drug Interactions

When starting a new medication, it's important to review potential drug interactions with your doctor. This helps avoid complications and ensures the medication works properly. Trintellix has some notable drug interactions to be aware of.

  • Monoamine oxidase inhibitors (MAOIs): Do not take Trintellix within 14 days of stopping a monoamine oxidase inhibitor (MAOI) antidepressant or take an MAOI within 21 days of stopping Trintellix. Combining these can cause serotonin syndrome, a potentially life-threatening condition with symptoms like high fever, stiff muscles, confusion, and seizures. MAOIs include selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, and methylene blue.
  • Serotonergic drugs: Taking Trintellix alongside other serotonergic medications may increase your risk of serotonin syndrome. These include SNRIs, SSRIs, tricyclic antidepressants, fentanyl, lithium, tramadol, amphetamines, tryptophan, and St. John’s Wort. 
  • CYP2D6 inhibitors prevent the breakdown of Trintellix, leading to high amounts in the blood and further raising serotonin syndrome risk. Examples include bupropion, fluoxetine, paroxetine, and quinidine.
  • CYP inducers like rifampin, carbamazepine, and phenytoin speed up Trintellix breakdown, potentially making it less effective.
  • Blood thinners: combining Trintellix with blood thinners such as apixaban, aspirin, dabigatran or warfarin increases the chance of stomach bleeding.[1]

Trintellix Withdrawal

If you have been taking Trintellix and wish to stop taking it, talk to your doctor first. Stopping Trintellix abruptly can lead to withdrawal side effects such as:

  • Irritability
  • Sudden worsening of mood
  • Nervousness
  • Agitation
  • Muscle tension
  • Headaches [1]

Your doctor will consider your current Trintellix dosage and create a plan to lower and discontinue it gradually. This helps your body adjust slowly to avoid withdrawal effects.

  • If you take 15 to 20 mg of Trintellix daily, your doctor may have you decrease it to 10 mg daily for at least a week before entirely stopping.
  • If you have been on a lower daily dose of 10 mg or 5 mg, it may be possible to discontinue Trintellix without tapering. However, it is still advisable to consult your doctor before changing your medication regimen. [1]

Trintellix During Pregnancy

a pregnant woman sitting on a bed

If you are pregnant or planning to conceive, it is crucial to consider the potential effects of Trintellix on your pregnancy and your baby's development. Unfortunately, due to insufficient human studies, the question of whether Trintellix is entirely safe to use during pregnancy remains uncertain. While animal studies have indicated potential risks to fetuses exposed to the drug, it is important to note that findings from animal studies do not always directly translate to humans. [1]

Based on the limited research available, there are two considerations for Trintellix usage during pregnancy:

  • Research on other antidepressants has shown that their use during pregnancy, particularly in the third trimester, can lead to complications in newborns, such as difficulties in breathing, seizures, irritability, and feeding problems. 
  • Discontinuing Trintellix treatment during pregnancy may also have consequences, as it could result in the return of depressive symptoms. [1]

Navigating this complex situation requires careful consideration of the risks associated with either continuing or stopping Trintellix during pregnancy. Your doctor is your best resource and can guide you on how Trintellix may impact your pregnancy and your baby's development.


Trintellix can be an effective treatment for major depressive disorder, but a comprehensive understanding of the medication is important. Like all antidepressants, Trintellix may cause side effects in some individuals, and it can interact with other drugs or supplements.

Discussing concerns about side effects or withdrawal symptoms with your doctor can help determine whether adjustments or alternatives may be better.

To learn more about Trintellix, visit our Trintellix blog.

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis, or treatment.