Managing Nausea from Trintellix (Vortioxetine)

First-Line Management Strategies

Taking Trintellix with food, preferably with the largest meal of the day, can help manage nausea, and considering splitting the dose and taking with separate meals if a single daily dose causes intolerable nausea, or taking the medication at bedtime to avoid the burden of nausea during waking hours, as recommended by the American Society of Clinical Oncology, is a viable strategy 1
First-line antiemetics, such as Dopamine receptor antagonists, including Prochlorperazine 5-10 mg 3-4 times daily, can be used to manage nausea, according to the National Comprehensive Cancer Network 2
Metoclopramide, which has both antiemetic and prokinetic properties, can be used as a first-line antiemetic, as suggested by the Journal of the National Comprehensive Cancer Network 3, 2

Second-line antiemetics, such as 5-HT3 receptor antagonists, including Ondansetron 4-8 mg 2-3 times daily, can be used for persistent nausea, as recommended by the National Comprehensive Cancer Network 4, 2
Alternative agents, such as Olanzapine, can be used for refractory cases, particularly in palliative settings, as suggested by the Journal of the National Comprehensive Cancer Network 4, 2

Administering antiemetics around-the-clock for 1 week, then adjusting dosing as needed, can help manage persistent nausea, according to the Journal of the National Comprehensive Cancer Network 4
Adding therapies targeting different mechanisms, rather than replacing one antiemetic with another, can have a synergistic effect, as suggested by the Journal of the National Comprehensive Cancer Network 3, 4

Proton pump inhibitors, such as Protonix/pantoprazole, should not be used as first-line treatment for Trintellix-induced nausea, unless nausea is specifically related to gastritis or GERD, as recommended by the American Gastroenterological Association 2