Serzone, Nefazodone 5HT2 (nefazodone) dosing, indications, interactions, adverse effects, and more

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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

50mg
100mg
150mg
200mg
250mg

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

Interaction Checker

Enter a drug name and nefazodone

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Interactions Found

Contraindicated

Serious - Use Alternative

Significant - Monitor Closely

Minor

All Interactions Sort By:

>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)

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

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.

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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Patient Handout

Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

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Create Your List of Plans

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.

View explanations for tiers and restrictions

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.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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Sections nefazodone
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
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Patient Handout
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nefazodone (Rx)