DURING CONCOMITANT USE OF A STRONG CYP3A4 INHIBITOR (E.G., ITRACONAZOLE, CLARITHROMYCIN, VORICONAZOLE), THE VILAZODONE DOSE SHOULD NOT EXCEED 20 MG ONCE DAILY.
CONSIDER INCREASING THE DOSAGE OF VIIBRYD BY 2-FOLD, UP TO A MAXIMUM 80 MG ONCE DAILY, OVER 1 TO 2 WEEKS IN PATIENTS TAKING STRONG CYP3A4 INDUCERS (E.G., CARBAMAZEPINE, PHENYTOIN, RIFAMPIN) FOR GREATER THAN 14 DAYS. IF CYP3A4 INDUCERS ARE DISCONTINUED, GRADUALLY REDUCE THE VIIBRYD DOSAGE TO ITS ORIGINAL LEVEL OVER 1 TO 2 WEEKS.
SNRIS AND SSRIS, INCLUDING VILAZODONE, CAN PRECIPITATE SEROTONIN SYNDROME, A POTENTIALLY LIFE-THREATENING CONDITION. THE RISK IS INCREASED WITH CONCOMITANT USE OF OTHER SEROTONERGIC DRUGS (INCLUDING TRIPTANS, TRICYCLIC ANTIDEPRESSANTS, FENTANYL, LITHIUM, TRAMADOL, TRYPTOPHAN, BUSPIRONE, AMPHETAMINES, AND ST. JOHN'S WORT) AND WITH DRUGS THAT IMPAIR METABOLISM OF SEROTONIN, I.E., MAOIS. SEROTONIN SYNDROME CAN ALSO OCCUR WHEN THESE DRUGS ARE USED ALONE.
VILAZODONE INCREASES RISK OF BLEEDING EVENTS FROM ECCHYMOSIS, HEMATOMA, EPISTAXIS, AND PETECHIAE TO LIFE-THREATENING HEMORRHAGES ON CONCOMITANT USE OF NSAIDS, OTHER ANTIPLATELET DRUGS, WARFARIN, AND OTHER ANTICOAGULANTS.