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nefazodone (Rx)Brand and Other Names:Serzone, Nefazodone 5HT2, more...Serzone 5HT2

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 50mg
  • 100mg
  • 150mg
  • 200mg
  • 250mg
more...

Depression

Initial: 100 mg PO q12hr

Increase by 50-100 mg/dose at 1 week intervals

Geriatric

Initial: 50 mg PO q12hr (reduced clearance, increased side effects)

Increase by 50-100 mg/dose at 1 week intervals

Maintenance: 200-400 mg/day divided q12hr

Safety & efficacy not established

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Interactions

Interaction Checker

nefazodone and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Headache (31-35%)

            Somnolence (21-25%)

            Nausea (21-25%)

            Xerostomia (21-25%)

            Dizziness (15-20%)

            Asthenia (11-15%)

            Constipation (11-15%)

            Insomnia (11-15%)

            1-10%

            Infection (6-10%)

            Dyspepsia (6-10%)

            Lightheadedness (6-10%)

            Confusion (6-10%)

            Blurred vision (6-10%)

            Abnormal vision (6-10%)

            Increased appetite (1-5%)

            Memory loss (1-5%)

            Paresthesia (1-5%)

            Vasodilation (1-5%)

            Decreased concentration (1-5%)

            Ataxia (1-5%)

            Decreased libido (1-5%)

            Breast pain (1-5%)

            Decreased hematocrit (1-5%)

            Agitation with discontinuation (1-5%)

            Orthostatic hypotension (2.6%)

            Bradycardia (1.5%)

            Frequency Not Defined

            Hypomania

            Mania

            Seizure

            Suicidal thoughts

            Suicide

            Worsening depression

            Liver failure (rare, 1 in 250,000-300,000)

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            In children and young adults, risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients

            Contraindications

            Co-administration with terfenadine (discontinued), astemizole (discontinued), cisapride, pimozide, carbamazepine

            Concurrent administration with alprazolam or triazolam (reduce dose by 50% and 75%, respectively)

            Hypersensitivity to nefazadone or other phenylpiperazine antidepressants

            Co-administration with MAO inhibitors or within 14 days of administration

            Avoid during breast-feeding

            Cautions

            Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 yo)

            May take several weeks to achieve full response

            May cause anticholinergic effects

            Use caution in patients experiencing xerostomia, visual problems, paralytic ileus, BPH, urinary retention, or decreased motility

            Hepatic failure associated with nefazodone use

            Sedation may occur; may impair physical or mental abilities

            Orthostatic hypotension may occur

            Discontinue MAOI 14 d before nefazodone

            Discontinue nefazodone 7 d before starting an MAOI

            Discontinued in Canada following severe adverse hepatic events

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Antidepressant structurally unrelated to SSRI, tricyclics, tetracyclics, or MAO inhibitors but inhibits neuronal reuptake of serotonin & norepinephrine; it is also a 5-HT2 and alpha1 receptor antagonist

            Pharmacokinetics

            Half-life elimination: 2-4 hrs

            Peak Plasma Time: 1 hr

            Bioavailability: 20% (decreased by food)

            Protein Bound: >99%

            Vd: 0.22-0.87 L/kg

            Metabolism: hepatic P450 enzyme CYP3A4

            Metabolites: hydroxynefazodone (HO-NEF), metachlorphenylpiperazine (mCPP)

            Excretion: Urine (55%); feces (20-30%)

            Dialyzable: No

            Enzymes inhibited: CYP3A4

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
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            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

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