Serzone (Nefazodone) Medication Profile

NOTE: Serzone was pulled off the market in the United States in May 2004 due to the possibility of liver failure, but the generic nefazodone is still available, and Serzone is available in some other countries. If you are taking this medication, discuss this with both your psychiatrist and your primary care doctor. They may wish to do regular liver enzyme tests while you are taking Serzone or nefazodone.

Nefazodone is an SNRI antidepressant appropriate for treatment of depression with or without anxiety or sleeplessness. It may be particularly useful where anxiety and/or sleeplessness accompany depression. As with all antidepressants, in the United States nefazodone carries the black box warning regarding suicidality in children and teens.

Dosage
According to U.S. patient information, the manufacturer's recommended starting dose is 200 mg/day in two doses, morning and evening. However, sample packs of Serzone, when they were available, started the patient at just 50 mg, twice a day, for the first week. The dosage can be raised after one week or when side effects are gone. Dosage should then be gradually increased, waiting for side effects to subside before going up to a new level. In clinical trials, the effective dose range was generally 300 to 600 mg/day. It is important not to start at too high a dosage, in order to keep side effects controlled.

Some improvement, especially in anxiety and sleeplessness (if present), should be felt by the patient within the first week or two, but it can several weeks to a few months for the full benefits of nefazodone to be experienced.

Drug Interactions
Consult your doctor before taking nefazodone if you are also taking any of the following medications, because serious interactions may occur:

• Tegretol (carbamazepine) - often prescribed as a mood stabilizer for bipolar disorder
• Hismanal (astemizole) - an allergy medication
• Orap (pimozide) - an antipsychotic medication
• Propulsid (cisapride) - a medication for acid reflux disease
• Any MAOI antidepressant
• Halcion (triazolam) - an anti-anxiety medication
• Xanax (alprazolam) - an anti-anxiety medication

Allow two weeks between stopping any MAOI and starting nefazodone, and one week between discontinuing nefazodone and starting treatment with any MAOI.

There are many other drug interactions with nefazodone, so read the patient information accompanying your prescription completely and notify your doctor if you discover any potential problems.

Also, the manufacturer recommends against using nefazodone while pregnant or nursing.

Warning
In rare cases, people taking nefazodone have developed serious liver problems. If you notice any of the following symptoms, call your doctor immediately:

• Yellowing of the skin or whites of eyes (jaundice)
• Unusually dark urine
• Loss of appetite that lasts several days or longer
• Nausea
• Abdominal (lower stomach) pain

People who already have any liver problems should not take this medication.

Side Effects
Nefazodone operates by inhibiting the reuptake of serotonin and norepinephrine, brain chemicals that are associated with depression. However, unlike the SSRI antidepressants, it is associated with minimal weight gain and minimal sexual side effects. In addition, the reported activation of mania/hypomania was lower with nefazodone than with some other antidepressants in bipolar patients, but some risk remains, so patients should be monitored for the onset of mania or hypomania when taking this or any antidepressant.

Most common listed side effects include:

• headache
• dry mouth
• nausea
• constipation
• drowsiness
• dizziness
• diarrhea
• insomnia
• lightheadedness

Drowsiness was the most common, even at lower dosages, which explains why this medication is often used to treat patients whose depression is accompanied by insomnia. Nausea, constipation, dizziness, abnormal and blurred vision were all more common at dosages higher than 300 mg/day.

References
Medline Plus Drug Information (4/1/05). Nefazodone. 2/2/07.

Gold Standard (8/14/06). Nefazodone. 2/2/07.

Bristol-Myers Squibb. "Serzone Patient Information." 2000.