Serotonin Syndrome With Standard-Dose Vilazodone (Viibryd ® ) Monotherapy

Abstract

There is a deficiency in published literature describing serotonin syndrome with standard vilazodone (Viibryd®) treatment. This is the case of a 28-year-old female with anxiety treated with vilazodone. Prior to the initiation of vilazodone, vital signs were normal and the patient exhibited no signs of excessive serotonin. The patient was prescribed vilazodone with the appropriate 2-week titration per the FDA-approved prescribing information. During the first week, the patient reported excessive perspiration and gastrointestinal symptoms. On day 17 of vilazodone therapy, the patient reported a major neurologic reaction and discontinued vilazodone. The patient was diagnosed with possible serotonin syndrome. Symptoms of elevated serotonin, including hyperhidrosis and nausea, did not resolve until 2 weeks after discontinuation of therapy. In this case, the patient developed early warning signs of excessive serotonin in the periphery and eventually a potential life-threatening neurologic adverse event on vilazodone monotherapy. Practitioners should counsel on early warning signs of excessive serotonin and the potential for serotonin syndrome, even with a single serotonergic agent. J Med Cases. 2014;5(11):567-569 doi: http://dx.doi.org/10.14740/jmc1956w