Nefazodone

Brand names

• Lin-Nefazodone
• Serzone

Usage

To treat symptoms of major depression.

How it works

Nefazodone affects the levels of serotonin and norepinephrine, brain chemicals that are thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Blurred, partial loss of, or changes in vision; unsteadiness or clumsiness; skin rash; lightheadedness; ringing in the ears; prolonged or painful erection (lasting more than 4 hours).

Common

Drowsiness or dizziness, agitation, dry mouth, confusion, constipation or diarrhea, unusual dreams, heartburn, fever or chills, insomnia, loss of memory, headache, flushing, nausea or vomiting, increased appetite.

Less common

Joint pain, increased thirst, breast pain, cough, swelling of lower extremities, sore throat, trembling. Also unusual tingling, burning, or prickling sensations.

Possible interactions

Other medicaments:

Nefazodone may increase the effects of:

• alprazolam (Xanax) and potentially other benzodiazepines.
• carbamazepine (Tegretol).
• cisapride (Propulsid), leading to possible heart toxicity.
• digoxin (Lanoxin); increased blood level checks are suggested.
• dofetilide (Tikosyn); increased blood level checks are suggested.
• flecainide (Tambocor); blood level checks are prudent.
• haloperidol (Haldol).
• imipramine (Tofranil).
• tacrolimus (Prograf); increased blood level checks are suggested.
• triazolam (Halcion).

Nefazodone taken concurrently with:



• acebutolol (Sectral) and perhaps other beta blockers may result in decreased acebutolol levels and increased nefazodone metabolites.
• astemizole (Hismanal) can cause serious heart toxicity.
• atorvastatin, lovastatin, simvastatin and other HMG-CoA reductase inhibitors may increase risk of muscle damage if combined with nefazodone.
• buspirone (Buspar) resulted in liver enzyme increases with a similar medicament (trazodone).
• clozapine (Clozaril) may result in clozapine toxicity since the P450 system in the liver is involved in removing clozapine from the liver.
• cyclosporine (Sandimmune) may result in cyclosporine toxicity. Dosing adjustments may be needed.
• dextromethorphan (in cough medicines with DM on the label) may result in dextromethorphan toxicity since the P450 system in the liver is involved in removing dextromethorphan from the liver.
• MAO inhibitors may cause serious toxicity.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) may result in increased phenytoin or fosphenytoin levels; more frequent blood level checks are needed, and dosing should be adjusted to blood level results.
• ritonavir (Norvir) may lead to toxicity.
• rizatriptan (Maxalt) and other triptans may lead to loss of coordination, weakness and reflex problems.
• sibutramine (Meridia) increases risk of serotonin syndrome.
• terfenadine (Seldane) may cause serious heart rhythm problems.
• tricyclic antidepressants may result in increased tricyclic antidepressant levels and toxicity.
• tryptophan (various) may lead to toxicity.

Herbal medicines or minerals:

Since nefazodone and St. John's wort may act to increase serotonin, the combination is not advised. St. John's wort may also worsen sensitivity to the sun. Since part of the way ginseng works may be as a MAO inhibitor, do not combine ginseng with nefazodone. Indian snakeroot, ma huang and yohimbe are also best avoided while taking this medicine. Kava and valerian may worsen drowsiness. The FDA has allowed one dietary supplement called Cholestin to continue to be sold. This preparation actually contains lovastatin. Since use of an HMG-CoA inhibitor with nefazodone may increase risk of rhabdomyolysis or myopathy, the combination is not advised.

Beverages:

Grapefruit juice may lead to toxicity.

Alcohol:

This combination is not recommended.

Marijuana smoking:

Increased somnolence.

Exposure to sun:

Use caution-photosensitivity is possible.

Discontinuation:

Do not stop this medication without discussing this with your doctor.