Exxua vs. Viibryd for Depression: 5 Differences Between These Antidepressants
Key takeaways:
Exxua (gepirone) and Viibryd (vilazodone) are medications that are thought to treat depression by increasing serotonin activity in the brain. But they each do this in a different way. They also have unique side effects.
Your healthcare provider may need to monitor your heart rhythm before and during Exxua treatment. This is because Exxua can cause electrical changes in the heart, resulting in abnormal heart rhythms in some people.
Viibryd can increase the risk of bleeding. This risk may be higher if you take it with other medications that thin your blood. You’ll need to watch for signs of bleeding, like unusual bruising while taking Viibryd.
Viibryd is currently available as a brand-name medication and lower-cost generic. With a free GoodRx coupon, you may be able to save over 70% off the average retail price of the generic version. Exxua is expected to launch in early 2024. The manufacturer may offer a copay savings card at that time.
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Table of contents
Many medications that treat depression are thought to work by targeting a brain chemical called serotonin, which helps regulate mood and emotions. But these antidepressants don’t necessarily affect serotonin activity in the same way.
Selective serotonin reuptake inhibitors (SSRIs), for example, make more serotonin available in the brain. Viibryd (vilazodone) mostly works as an SSRI. But it also has some overlapping effects with the 5HT1A receptor agonist, Exxua (gepirone), a newly FDA-approved antidepressant.
Both Exxua and Viibryd may be less likely to cause certain side effects that are common with certain other antidepressants, such as weight gain. But how exactly are they different, and how do you decide which is right for you? Below, we explore five differences between Exxua and Viibryd.
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1. Exxua and Viibryd work differently for depression
Exxua and Viibryd activate 5HT1A serotonin receptors (binding sites) in the brain, which may play a role in depression symptoms. Both medications are considered partial agonists, meaning that they don’t activate the receptors as strongly as natural serotonin.
In addition to activating 5HT1A receptors, Viibryd also helps make more serotonin available in the brain, similar to the way that SSRIs do. It does this by preventing serotonin from being reabsorbed by nerve cells, allowing it to stick around longer in the brain. This is the main way Viibryd is thought to work for depression.
Exxua and Viibryd haven’t been compared directly to each other in studies. So we don’t know if the differences in how they work makes one medication more effective than the other. However, it may result in different side effects, which is covered next.
2. Exxua may increase the risk of abnormal heart rhythms
If you’re taking Exxua, there’s a potentially serious side effect you should be aware of. Exxua can change your heart’s electrical activity by lengthening the QT interval, or the time it takes your heart to reset in between beats. Viibryd isn’t known to have this effect.
A prolonged QT interval can increase the risk of life-threatening abnormal heart rhythms (arrhythmias). Because of this, your healthcare provider will likely order an EKG before you start taking Exxua. Additional EKGs may be performed after dosage changes and periodically during treatment.
Certain electrolyte imbalances can increase the risk of QT prolongation. The risk is also higher if you take Exxua with other medications that can prolong the QT interval. So your healthcare provider may also check your electrolytes and review your current medication list before you start treatment.
QT interval prolongation doesn’t always cause noticeable side effects. That’s why routine EKGs are recommended. If you notice a fast or irregular heartbeat, however, get medical attention right away. If you feel like you’re going to faint, call 911 or go to the nearest emergency room.
Good to know: Exxua isn’t the only antidepressant that can prolong the QT interval. Other examples include citalopram (Celexa), escitalopram (Lexapro), and amitriptyline.
3. Viibryd can increase the risk of bleeding
Like SSRIs, Viibryd can increase your risk of bleeding, a side effect that hasn’t been reported with Exxua. Bleeding related to Viibryd can cause a range of issues, from small bruises to life-threatening events. Because of this, you’ll need to monitor for signs of bleeding — such as increased bruising, nosebleeds, or blood in your stool — while taking the medication.
The risk of bleeding may be higher if you’re taking Viibryd with other medications that can cause bleeding. Examples of these medications include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil)
Antiplatelet medications such as aspirin and clopidogrel (Plavix)
Anticoagulant medications such as warfarin and apixaban (Eliquis)
Before starting treatment with Viibryd, notify your healthcare provider if you’re taking any of these medications. And contact them right away if you notice unusual bruising or bleeding during treatment.
4. Sexual side effects haven’t been reported with Exxua
Many antidepressants, including Viibryd, can lead to sexual dysfunction as a side effect. But this may not be the case with Exxua.
During clinical trials, people taking Exxua and people taking a placebo (a pill without medication) experienced similar rates of sexual dysfunction. Because of this, sexual problems aren’t listed as a potential side effect of Exxua.
Exxua has a chemical structure that’s similar to buspirone. Buspirone is an anti-anxiety medication that’s sometimes prescribed off-label to help with sexual side effects from antidepressants. So it’s perhaps not surprising that sexual side effects weren’t seen with Exxua in clinic trials. Though, more research is needed to rule out the possibility of these side effects.
If you’re having difficulty sticking with your antidepressant due to sexual side effects, Exxua may be a potential alternative.
Keep in mind: If you are experiencing sexual dysfunction, it could also be related to depression. Talk to your healthcare provider about treatment options to help.
5. Exxua requires dosage adjustments for liver and kidney problems
Your liver and kidneys play an important role in breaking down and removing medications from your body. But if they’re not working as well due to liver disease or kidney disease, certain medications may not be cleared as efficiently. In this case, Exxua is affected by liver and kidney problems, while Viibryd is not.
If you have liver or kidney problems, the recommended maximum Exxua dosage is lower than what’s typical. This is to prevent Exxua, which is broken down by the liver, from building up in your body. While Viibryd is also broken down by the liver, you can take the typical recommended dosage if you have liver or kidney problems.
However, medications that interfere with how the liver breaks down other medications can be problematic for both Exxua and Viibryd. Some of these medications should be avoided when taking Exxua or Viibryd. In other cases, the potential interaction can be managed with a lower dosage.
How to save on Exxua and Viibryd
Viibryd is available as a brand-name medication and lower-cost generic (vilazodone). With a free GoodRx coupon, you may be able to pay as little as $34.00 for the generic version of Viibryd at certain pharmacies.
Since the FDA only approved Exxua in September 2023, it’s not available in pharmacies yet. But it’s expected to launch in early 2024. Once available, the manufacturer may offer a copay savings card to help make your prescription more affordable. Check back with GoodRx about that and other ways to save.
The bottom line
Exxua (gepirone) and Viibryd (vilazodone) are two medications approved to treat depression. They both increase serotonin activity in the brain, but in different ways. While both activate 5HT1A serotonin receptors (binding sites), Viibryd mainly works by making more serotonin available.
The medications also have different side effects and risks. Exxua can cause electrical activity changes in the heart, while Viibryd can increase the risk of bleeding. Exxua may be less likely to cause sexual problems.
Speak with your healthcare provider if you have questions about Exxua and Viibryd. Depending on your preferences, health history, and other factors, these antidepressants may be possible treatment options.
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References
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Berg, K. A., et al. (2018). Making sense of pharmacology: Inverse agonism and functional selectivity. International Journal of Neuropsychopharmacology.
Castro, V. M., et al. (2013). QT interval and antidepressant use: A cross sectional study of electronic health records. British Medical Journal.
Chauhan, M., et al. (2022). Vilazodone for major depression in adults: Pharmacological profile and an updated review for clinical practice. Neuropsychiatric Disease and Treatment.
Fabre-Kramer Pharmaceuticals, Inc. (2023). Fabre-Kramer Pharmaceuticals announces FDA approval of Exxua, the first and only oral selective 5HT1a receptor agonist for the treatment of major depressive disorder in adults. PR Newswire.
Mission Pharmacal Company. (2023). Exxua (gepirone) extended-release tablets, for oral use [package insert].
National Heart, Lung, and Blood Institute. (2022). Long QT syndrome.
ScienceDirect. (n.d.). Azapirone - An overview.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
