|US brand name: Serzone|
|Generic name: nefazodone|
side effects, dosage, how to take & discontinue, uses, pros & cons, and more
Table of Contents (hide)
- 1. FDA Approved Uses of nefazodone
- 2. Off-Label Uses of nefazodone
- 3. Nefazodone’s pros and cons
- 4. Serzone’s Side Effects
- 5. Interesting Stuff Your Doctor Probably Won’t Tell You about Serzone
- 6. Serzone’s (nefazodone) Dosage and How to Take Nefazodone
- 7. How Long Serzone Takes to Work
- 8. How to Stop Taking Nefazodone
- 9. Serzone’s (nefazodone’s) Half-Life & Average Time to Clear Out of Your System
- 10. Days to Reach a Steady State
- 11. How Nefazodone Works
- 12. Comments
- 13. Serzone Ratings, Reviews, & Other Sites of Interest
- 14. References
- Combat PTSD
- Social phobia
- bipolar depression
- postpartum depression
- sexual dysfunction caused by other antidepressants (especially with women)
- insomnia and other sleep disorders.
Good luck getting any doctor to prescribe nefazodone for depression, let alone an off-label application.
Highly effective, especially in preventing relapses. Low instances of sexual side effects.
Doctors are afraid to prescribe it, which is probably just as well because it will probably get pulled from the market completely any day now. Lots and lots of drug-drug interactions.
The usual anticholinergic-like side effects one gets with meds that have a positive effect on both serotonin and norepinephrine: headache, nausea, dry mouth, sweating, dizziness, blurred vision, sleepiness or insomnia, and constipation. Because nefazodone isn’t much of an anticholinergic none of these sticks around very much. Except for the sleepiness.
Urinary retention or hesitancy, which is something that either sticks around or strikes at random. A variety of vision weirdness - go ahead and get your eyes checked, but if an eye doctor doesn’t find anything on a cursory examination, it’s not your eyes, it’s the Serzone. Priapism. Liver problems severe enough that you have to immediately stop taking it, which is why nefazodone has been yanked from the market most everywhere.
The inability to produce clear speech. 3-day long clitoral priapism
They don’t know if you should take nefazodone with food or not. With most drugs they can tell if it’s a good idea, a bad idea, or, as is usually the case, it doesn’t make any difference. The bioavailability of Serzone is bad enough to start (20% or less), or maybe not. The data are all over the map with this med. You don’t want to make it worse, but the data are conflicting! The obvious things to do are:
1. Ask your pharmacist. My money is on the answer being to take it on an empty stomach, because the PI sheet states:
Food delays the absorption of nefazodone and decreases the bioavailability of nefazodone by approximately 20%. — Serzone PI sheet
2. If you’re taking nefazodone on an empty stomach and it makes you want to puke, try taking it with food.
Nefazodone is structurally related to Abilify, even though the two don’t even come close to doing the same thing.
Apparently nefazodone has a discontinuation syndrome that is almost Effexor-like in severity. Which is just fabulous for anyone who lives somewhere it becomes suddenly unavailable.
The official recommendation:
The recommended starting dose for nefazodone HCl is 200 mg/day, administered in 2 divided doses (bid). In the controlled clinical trials establishing the antidepressant efficacy of nefazodone HCl, the effective dose range was generally 300–600 mg/day. — Serzone PI sheet
What we suggest: Start with 100mg at night, then gradually add 50–100mg, dividing it into however much in the morning and night works best for you, until your symptoms stop. We also suggest not taking more than 500mg a day.
Pretty much like trazodone, except with a higher dosage. 50–100mg at night.
Like trazodone, if you’re taking nefazodone for sleep it can start working in one or two days. Otherwise anywhere from one to six weeks.
Unless your liver has imploded, slowly and carefully. As in reducing your dosage by 50mg a day every five to seven days. You can try for a faster discontinuation, but if you start to feel the symptoms of withdrawal, consider my suggestion.
Nefazodone discontinuation syndrome
switching to an SSRI may not help
Nefazodone itself has a half-life of 2–4 hours. Nefazodone has three active metabolites with half-lives that range from 3–18 hours. With its really shitty bioavailability and protein binding (both around 20%) I’m surprised it hasn’t cleared your system five minutes after you take it. Nefazodone is probably gone in three to five days, and that’s both plasma and tissue clearance.
These short half-lives and crappy bioavailability are similar to Effexor’s, and help to explain why Serzone has a similarly nasty discontinuation syndrome. Although sometimes it seems to have a bioavailability and protein binding above 90%.
Usually two to three days. Maybe. As nefazodone’s pharmacokinetics are non-linear, and apparently fungible, and all three of its active metabolites contribute to what it does, your guess is as good as mine.
Like trazodone Serzone is a serotonin reuptake inhibitor that also blocks action at the serotonin 5HT2A and 5HT2C receptors, although one of its metabolites may also be an agonist at 5HT2C, thus counteracting what would normally suppress serotonin reuptake inhibitor side effects like weight gain and anxiety. It is also a moderate antagonist at 5HT1A, and norepinephrine alpha-1. The data are conflicting about how much of an antihistamine it is, but my money is on it being a decent one, otherwise it wouldn’t be as good for sleep as it is. At its higher dosages it is also enough of a norepinephrine and perhaps even dopamine reuptake inhibitor to make a difference.
Poor Serzone. I bet if the problems it can cause with your liver came to light today instead of at the height of anti-antidepressant hysteria in the early 2000s it would still be on the market. It has the pharmacodynamic profile (how it works) of a nearly perfect antidepressant. Too bad its pharmacokinetics (half-life and such) suck so hard that even if it one of its metabolites didn’t hose everything with 5HT2C agonism, the short half-lives and general unpredictability that lead to a discontinuation syndrome, and lots of drug-drug interactions would rule it out.
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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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Physicians’ Desk Reference Edition 53 © 1999. Published by Medical Economics Company.
Consumer’s Guide to Psychiatric Drugs by John D. Preston Psy.D., John H. O’Neal, M.D. & Mary C. Talaga R.Ph., M.A. © 2000. Published by New Harbinger Publications.
Psychopharmacology of Antidepressants Stephen M. Stahl, M.D., Ph. D. © 1997. Published by Martin Dunitz
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If you have any questions not answered here, please see the Crazymeds Serzone discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
|Last modified on Monday, 20 January, 2014 at 15:31:50 by SomeMedCritic||Page Author Jerod Poore||Date created|
|“Serzone (nefazodone): a Review for the Educated Consumer.” by Jerod Poore is copyright © Jerod Poore||Published online 2011/03/26|
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
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* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.