Nefazodone
SERZONE
What it isSerotonin 5-HT2 antagonist and reuptake inhibitor; depression.
Why this oneIt causes little sexual dysfunction and does not suppress REM sleep, unlike most antidepressants.
What limits itRare but fatal hepatic failure ended its widespread use. A strong CYP3A4 inhibitor.
FDA-approved for
- depression (1994)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Depression | Adults | 200 mg/day BID | 300–600 mg/day BID | 600 mg/day |
| Depression | Elderly/debilitated | 100 mg/day BID | titrate to response | 600 mg/day |
Titration Increase in increments of 100–200 mg/day at intervals of no less than 1 week
Renal Undefined
Hepatic Undefined (contraindicated if prior nefazodone-associated liver injury)
Instructions
- Allow ≥14 days after stopping an MAOI before starting nefazodone
- Allow ≥7 days after stopping nefazodone before starting an MAOI
Contraindications
- Prior withdrawal from nefazodone due to evidence of liver injury
- Coadministration with carbamazepine, pimozide, cisapride, terfenadine, or astemizole
Cautions
- MAOIs due to risk of serotonin syndrome
- Hepatotoxicity / hepatic failure (can be fatal)
- Suicidality
- Postural hypotension
- Visual disturbances (blurred/abnormal vision, scotomata)
Adverse reactions
- Somnolence
- Dry mouth
- Nausea
- Dizziness
- Constipation
- Asthenia
- Lightheadedness
- Blurred vision
- Confusion
- Headache
Pregnancy Category C; use only if potential benefit justifies risk to fetus
Lactation Undefined
⚠ BOXED WARNINGS
- Life-threatening hepatic failure
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$10–$300/month
Generic entry2003
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRare but potentially fatal hepatic failure and clinically important CYP3A inhibition.
Active metabolites
Mechanism of action: Nefazodone ballicule
Open Nefazodone in the interactive console ↗
Memory aids: mascots and interaction avatars
Strong CYP3A4 inHibitor
Boxed warning: acute liver failure
