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. Discussion board
- 14. Your Reviews of, Comments About, and Experiences with Serzone
- 15. wrote:
- 16. Full US PI sheet, Global SPCs & PILs, Consumer Reviews & Ratings Sites, check for drug-drug interactions
- 17. Bibliography
US Brand Name: Serzone
generic name: nefazodone
§1. FDA Approved Uses of nefazodone
§2. Off-Label Uses of nefazodone
- 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.
§3. Nefazodone’s pros and cons
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.
§4. Serzone’s Side Effects
§4.1 Nefazodone’s Typical Side Effects
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.
§4.2 Nefazodone’s Not So Common Side Effects
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.
§4.3 Nefazodone’s Freaky Rare Side Effects
The inability to produce clear speech. 3-day long clitoral priapism
§5. Interesting Stuff Your Doctor Probably Won’t Tell You about Serzone
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.
§6. Serzone’s (nefazodone) Dosage and How to Take Nefazodone
§6.1 For Depression
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.
§6.2 For Sleep
Pretty much like trazodone, except with a higher dosage. 50–100mg at night.
§7. How Long Serzone Takes to Work
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.
§8. How to Stop Taking Nefazodone
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
§9. Serzone’s (nefazodone’s) Half-Life & Average Time to Clear Out of Your System
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%.
§10. Days to Reach a Steady State
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.
§11. How Nefazodone Works
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.
§13. Discussion board
If you have any questions about Serzone (nefazodone), the best place to ask them is on the Crazy Meds’ Serzone (nefazodone) discussion board.
§14. Your Reviews of, Comments About, and Experiences with Serzone
26 March 2011 - 18:45
Jerod Poore wrote:
Tell us what you think about Serzone
I hope nefazadone is never pulled from the US market, and not only because after reading this I have to fear withdrawal.
In terms of side-effects vs. benefits, it’s the best med for my depression and anxiety I’ve ever taken. Side effects: Some tolerable drowsiness, which since I take most of it when I go to bed isn’t even a problem. And it has done more to keep depression and anxiety in check than anything else I’ve taken.
I use Cymbalta too, another SNRI. That’s good to take when I wake up, but the added norepinephrine, while energizing me, isn’t great anxiety-wise. SSRIs don’t do much for me. I’m fortunate to have a p-doc who will prescribe a benzo, but that helps with anxiety and not depression. I’ve been on AAPs and still am as needed, but the side effects suck.
Nefazadone has been great. I hope (as I do with benzos) that I never have to withdraw from it, and I further in this case have to hope that it stays on the market.
Enter your own Review, Comments & Experiences with Serzone here.
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§16. Full US PI sheet, Global SPCs & PILs, Consumer Reviews & Ratings Sites, check for drug-drug interactions
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
Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries © 2009 Published by Hogrefe & Huber Publishers.
Date created 26 Mar 2011 - 18:45 Page Author: JerodPoore Last edited by: Jerod Poore on November 12, 2012, at 05:23 PM
Serzone is a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.
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Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]
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