Nefazodone (Serzone)
Antidepressant (serotonin receptor antagonist (5-HT2), receptor agonist (5-HT1A))
- Major Depression3
- Similar to trazodone but less sedating
Features
Dosing
Start 200 mg qhs, raise by 200 mg every 7 days to target of 300-600 mg/day (usually divided bid but can give all at night if too sedating).
INTERACTIONS: Strong CYP3A4 inhibitor, raises carbamazepine, guanfacine, modafinil, antipsychotics, benzos, and z-hypnotics.
Management
Antagonist at serotonin 5-HT2A receptors (like trazodone, seroquel, zyprexa, mirtazapine – this causes sedation).
TOLERABILITY: Fatigue, dry mouth, nausea, dizziness, constipation, weakness, lightheadedness, and problems with vision. Lacks sexual side effects.
RISKS: Hepatotoxicity (1 in 250,000 to 300,000 patient-years of treatment). Hypotension.
MONITORING: LFTs annually.
EMR Text
Depression
Nefazodone use based on FDA approval in Major Depressive Disorder.
Nefazodone warnings, including liver risks, reviewed with patient.