side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

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US brand name: Serzone
Generic name: nefazodone

Class: Antidepressants Nefazodone is a serotonin-2 antagonist and reuptake inhibitor - (SARI) - like its chemical cousin trazodone.

1.  FDA Approved Uses of nefazodone

Depression

2.  Off-Label Uses of nefazodone

Good luck getting any doctor to prescribe nefazodone for depression, let alone an off-label application.

3.  Nefazodone’s pros and cons

3.1  Pros

Highly effective, especially in preventing relapses. Low instances of sexual side effects.

3.2  Cons

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.



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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.

12.  Comments

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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13.  Serzone Ratings, Reviews, & Other Sites of Interest

Serzone Ratings & Reviews Page.

13.1  Rate Serzone

Give your overall impression of Serzone on a scale of 0 to 5. Detailed ratings and reviews are available on the Serzone Ratings & Reviews Page.

Get all critical about Serzone

5 stars Rating 4.6 out of 5 from 17 criticisms.
Vote Distribution: 0 – 0 – 1 – 1 – 2 – 13


13.2  Rate this article

If you’re still feeling judgmental as well as just mental1, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Serzone (nefazodone) Synopsis

3 stars Rating 3.0 out of 5 from 1 value judgments.
Vote Distribution: 0 – 0 – 0 – 1 – 0 – 0


13.3  Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions

Serzone’s Full US Prescribing Information / PI Sheet

Drugs.com’s drug-drug and drug-food interaction checker

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.




13.4  Discussion board

If you have any questions not answered here, please see the Crazymeds Serzone discussion board.


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14.  Bibliography

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.

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007

Comparison of the Bioactivation Potential of the Antidepressant and Hepatotoxin Nefazodone with Aripiprazole, a Structural Analog and Marketed Drug

Contemporary approach to pharmacological and clinical aspects of novel antidepressants

Neurotransmitter Receptor and Transporter Binding Profile of Antidepressants and Their Metabolites


1 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!


If you have any questions not answered here, please see the Crazymeds Serzone discussion board. I 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 I write these damn things. I’m frustrated enough as it is. 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.


Last modified on Monday, 20 January, 2014 at 15:31:50 by SomeMedCriticPage Author: JerodPooreDate created Saturday, 26 March, 2011 at 18:45:46

Serzone by JerodPoore is copyright © 2011 JerodPoore


Serzone, and all other drug names on this page and use throughout the site, are 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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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.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
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 a forerunner of 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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