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.
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.
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
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.
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
- Abdominal (lower stomach) pain
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:
- dry mouth
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.