The People's Perspective on Medicine

Nefazodone

Overview

Prozac was the first of a new generation of antidepressants. It was followed by Paxil and Zoloft.

They work by enhancing the action of a brain chemical called serotonin and are called SSRIs (selective serotonin reuptake inhibitors).

Now there are additional compounds such as Serzone and Effexor (venlafaxine). Researchers do not understand the exact mechanism whereby these medicines relieve psychological depression.

They too affect serotonin and in addition modify levels of another brain chemical called norepinephrine. Such drugs are called SNRIs (serotonin/norepinephrine reuptake inhibitors).

The success of these new antidepressants comes largely because they are less likely to cause typical side effects associated with older medications.

Tricyclic antidepressants like Elavil, Tofranil, Sinequan and Pamelor can produce dry mouth, constipation, dizziness, weight gain, and a sluggish or lethargic feeling.

SSRIs such as Prozac, Paxil and Zoloft appear to share one common problem. Many people complain of sexual difficulties — less interest, less ability, and less enjoyment. Serzone may be somewhat less likely to muck up the sexual machinery.

Serzone has been approved for treatment of psychological depression. Symptoms of depression may include sleep disturbances, loss of interest in normal activities, feeling gloomy, down in the dumps, and sad longer than several weeks, loss of sex drive, loss of appetite, fatigue, feelings of restlessness or agitation, difficulty concentrating, and thoughts of suicide.

nefazodone

Side Effects and Interactions

Side effects associated with Serzone include drowsiness, dizziness, lightheadedness, weakness, dry mouth, insomnia, nausea, constipation, digestive tract upset, confusion, forgetfulness, agitation, visual disturbances, ringing in ears, increased appetite, and infection.

Less common adverse effects that have been reported include a decrease in heart rate, eye pain, lowered libido, impotence, unusual ejaculation, loss of orgasm, difficulty concentrating, flu symptoms, thirst, incoordination, cough, urinary difficulties, rash, itching, lowered hematocrit, liver test abnormalities, hangover effect, unsteadiness, hallucinations, breathing difficulties, and suicidal thoughts. Report any symptoms to your physician promptly.

Serzone interacts with a number of other medications.

Anyone taking certain antidepressants, especially drugs such as Nardil or Parnate, should stop such a medicine at least two weeks before starting on Serzone.

If Serzone was taken first, one week should elapse before starting on one of these other medicines. This interaction could be life threatening.

Three other medications that could be extremely hazardous in combination with Serzone include Seldane, Hismanal, and Propulsid. Irregular heart rhythms or cardiac arrest are possible consequences of such an interaction.

Xanax (alprazolam) and Halcion (triazolam) are both affected by Serzone. Blood levels of these drugs may increase dramatically and pose a significant hazard, especially for older people. Haldol (haloperidol), Inderal (propranolol), and Lanoxin (digoxin) may also be affected by Serzone.

Check with your pharmacist and physician before taking any other medicines.

Special Precautions

Serzone can interact in very dangerous ways with many other medications. Please check with a physician and pharmacist before starting Serzone if you are taking any other medications, or if you are taking Serzone and any other drug is added to the mix.

Some people experience low blood pressure while taking Serzone. This may be especially problematical when getting out of bed or standing suddenly (orthostatic hypotension). Dizziness or fainting may result.

This adverse effect is especially dangerous for people with cardiovascular conditions such as heart disease or a history of heart attack or stroke.

Anyone who is dehydrated or taking blood pressure medicine may also be at greater risk of this complication.

Patients with liver problems, irregular heart rhythms, or a history of seizures require careful monitoring while they are taking Serzone.

Older people and women may be more sensitive to Serzone. Dosage adjustments may be necessary, especially for older women.

Please point this situation out to your physician if you fit either category.

Before a woman becomes pregnant she should discuss the safety of Serzone with a physician beforehand.

People with a history of suicide attempts must also be extremely vigilant. Family members must help monitor people on Serzone for suicidal thoughts or self-destructive behaviors. The doctor must be notified immediately in such cases.

It often takes antidepressant medication several weeks to produce a noticeable improvement in mood. Patients and family members need to give Serzone a fair trial period to determine if it is proving beneficial.

Serzone may impair motor coordination, concentration, and judgment. Driving or operating machinery could be hazardous.

Taking the Medicine

According to the manufacturer, food slows and reduces absorption of Serzone (by about 20 percent).

The significance of this discovery is unclear and there are no recommendations to take the drug on an empty stomach.

Generally, patients are advised to take one pill twice daily. If the dose needs to be increased, it should be done gradually, at weekly intervals.

Older people and women may require lower doses than younger men. Only a physician can determine the appropriate dosing schedule.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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