Nefazodone (Oral)

Nefazodone is an oral medication that was prescribed to treat depression in some patients until 2004 when it was discontinued due to liver complications.

Overview

Nefazodone is an anti-depressant medication that is prescribed to patients with depression and other mood disorders. Due to a high risk of liver consequences, Nefazodone is often a last resort medication after other prescriptions don't work. The sale of this medication has been discontinued in the US since 2004.

Nefazodone works by connecting with chemicals in the brain known as neurotransmitters. By preventing an imbalance in these neurotransmitters by stopping their re-uptake, Nefazodone normalizes the levels of these chemicals, which has a direct effect on the mood of the patient.

It is estimated that, worldwide, there are over 300 million people who suffer from the mood disorder known as depression. Experts in the medical field have linked the low levels of two chemicals in the central nervous system with the condition of depression. These chemicals are norepinephrine and serotonin. Other medications such as MAOIs, SSRIs and TCAs are effective on the elevation of the levels of these two chemicals, but Nefazodone is not related to these types of drugs.

Instead, Nefazodone is more likened to another antidepressant known as Trazodone and named Desyrel, as they both function the same way. The advantage of Nefazodone is that it does not have any side effects related to the cardiovascular system nor does it seem to affect the sleep patterns in most patients. Unfortunately, Nefazodone has been linked to a high risk to liver health and has been discontinued for sale in many countries including the US.

Conditions Treated

  • Depression

Type Of Medicine

  • Antidepressant

Side Effects

Nefazodone affects chemicals found in the central nervous system that have direct links to the mood of the patient. In doing so, this medication may also cause unwanted effects on health that put the patient at risk for long-term issues. If you experience the following symptoms, let your physician know right away:

  • Vision changes or blurriness
  • Unsteady, clumsy demeanor
  • Fainting spells
  • Lightheaded
  • Ear noises such as ringing
  • Rash or itching on skin
  • Pain in the bladder
  • Urine that is cloudy or shows signs of blood
  • Hoarse voice
  • Coughing
  • Diarrhea
  • Muscles become more pronounced
  • Pain in the eyes
  • Dizzy
  • Frequent urination urge
  • Genital or vaginal itching
  • Stiffness in muscles
  • Tight, tense muscles
  • Nausea
  • Painful sex
  • Difficulty urinating with pain or burning sensation
  • Pain in stomach
  • Vaginal discharge that is white and thick, possibly odor
  • Difficulty breathing
  • Asthmatic symptoms
  • Rectal bleeding
  • Stools are tar-like or black
  • Sexual desire or performance changes
  • Pain in chest
  • Double vision
  • Eye dryness
  • Pain in the ears
  • Fainting spells
  • Rapid heart rhythm
  • Sore throat, chills, fever
  • Hallucinations
  • Hives
  • Hearing is super sensitive
  • Sun or light sensitivity
  • Muscle or joint pain
  • Kidney stones
  • Eye pupils are dilated
  • Pain in stomach, side or lower back
  • Changes in menstrual cycle
  • Mental change or moodiness
  • Twitching, painful nerves
  • Pain in pelvic region
  • Difficulty speaking
  • Urination difficulty
  • Penile erection that is prolonged, unexpected or painful
  • Irritated, red eyes
  • Facial swelling
  • Gland swelling
  • Overly excited demeanor
  • Bruising or bleeding that is unusual
  • Unusually calm demeanor
  • Weak, tired demeanor for no reason
  • Vomiting coffee-ground like material or blood

Other patients may have health symptoms that disappear over time with continued use of Nefazodone. These symptoms should still be reported to your physician in case they can be alleviated:

  • Strange dreams
  • Agitated mood
  • Confusion
  • Diarrhea
  • Constipation
  • Dizziness
  • Drowsy, sleepy
  • Mouth dryness
  • Warm feeling
  • Headache
  • Increased appetite
  • Coughing
  • Heartburn
  • Problems with memory
  • Nausea
  • Swollen legs or arms
  • Burning, prickling or tingling feelings
  • Tremors in muscles
  • Insomnia
  • Vomiting
  • Pain in breast
  • Physical and mental slowness
  • Thirsty
  • Weak muscles
  • Fatigue

Should you experience any of these health effects, or any effects other than the ones listed, they should be communicated to your physician right away.

Dosage

Nefazodone should be taken exactly as prescribed by your physician. Do not change the duration that you are supposed to be taking this drug and do not increase your daily dose, either in the amount your take or the frequency unless your doctor has made some alteration to your treatment.

This medication works best if you take it at the same time every day. It is possible that you will be directed to take Nefazodone with food to avoid upsetting your stomach. Even if you don't begin to feel better, keep in mind that it will take a while to build up the levels of serotonin and other neurotransmitters in your body. Stay on your drug treatment program for the long-term results that it will give you.

Your prescription of Nefazodone has been written with your specific condition in mind as well as other factors taken into consideration by your doctor. The information given here is general and should not take the place of what you have been prescribed. When in doubt, consult with your physician with any questions that you may have.

Adult patients who are over the age of 18 will typically be instructed to take 100 milligrams twice daily. This dose may be increased as required. Geriatric patients, due to age-related liver function challenges, will typically be given half this amount, for a 50 milligram twice daily dose. Again, this dose can be adjusted if required and safe. Children who are under 18 years old are typically not prescribed this drug unless the circumstances are unusual. In this case, the physician will determine the appropriate dosage.

According to the manufacturer, patients should not be given more than 600 milligrams total per day of Nefazodone. As this medication requires time to work on most patients, the adjustment of the dosage will be very gradual until the optimum amount is determined.

Missing your dose of Nefazodone is not advised, but if you accidentally forget, it is better to skip the missing dose than to double up on your medication if it is nearly time for your next one. When in doubt, check with your physician if you accidentally forget to take your Nefazodone.

Interactions

As a patient who has been diagnosed with depression, you may be prescribed other drugs to treat certain symptoms you have. You may also have health conditions that require other treatments. Keep in mind that some drugs do not react well together. For your own safety, make sure the doctor prescribing you Nefazodone to treat your depression symptoms is aware of any other medications that you take. Don't forget to let this doctor know if you take any pain medications that you can buy over the counter or any other non-prescription remedies you rely on. Tell your medical professional about what vitamins you take and any herbal teas or supplements you take as well.

You may have had a sensitive reaction to another medication or even to Nefazodone in the past and, if so, this should be disclosed to your doctor as well. Any reactions to pets, foods, dyes, perfumes or preservatives should also be communicated to your physician for your safety.

No specific data has been provided that was the result of any study performed on the pediatric population with regard to use of Nefazodone. Children under 18 years of age are not advised to take this drug unless a doctor has determined it is required. If so, caution should be used with regard to the dosage and consistent monitoring of the patient is recommended.

Children with depression are often at a higher risk for suicidal thoughts and actions as the result of taking Nefazodone. Without further study of this drug on this age group, it is advised that another form of treatment be recommended for pediatric patients.

Geriatric patients, due to age-related health conditions that affect the way their bodies absorb Nefazodone, indicate that this age group should have a lower dosage of the drug. For their own safety, dosage adjustment in geriatric patients is recommended.

Nefazodone has been demonstrated to cause fetal and infant harm and, for this reason, is not recommended as safe therapy in women who are pregnant or those who are breastfeeding. If you are breastfeeding, you may be advised to stop during your drug treatment therapy. Women who are pregnant should inform their doctors of this, especially if they become pregnant while already taking the drug. Talk to your physician immediately if you think you may be pregnant.

The following medications should be avoided when you are taking Nefazodone, as they could put your health at risk when combined:

  • Astemizole
  • Carbamazepine
  • Bromopride
  • Colchicine
  • Cisapride
  • Dihydroergotamine
  • Conivaptan
  • Eletriptan
  • Dronedarone
  • Eplerenone
  • Eliglustat
  • Ergonovine
  • Ergoloid Mesylates
  • Flibanserin
  • Ergotamine
  • Isavuconazonium Sulfate
  • Furazolidone
  • Ivabradine
  • Isocarboxazid
  • Lomitapide
  • Linezolid
  • Lurasidone
  • Lovastatin
  • Methylergonovine
  • Maraviroc
  • Naloxegol
  • Metoclopramide
  • Phenelzine
  • Nimodipine
  • Ranolazine
  • Pimozide
  • Simvastatin
  • Silodosin
  • Tolvaptan
  • Terfenadine
  • Venetoclax
  • Triazolam

While not recommended, you may require treatment from the following medications while you are on Nefazodone. If so, your doctor may alter your prescribed dosage of one or more of your medications to accommodate these drugs:

  • Abciximab
  • Acemetacin
  • Aceclofenac
  • Almotriptan
  • Ado-Trastuzumab Emtansine
  • Amitriptyline
  • Amiodarone
  • Amtolmetin Guacil
  • Amoxapine
  • Aprepitant
  • Apixaban
  • Atorvastatin
  • Aspirin
  • Axitinib
  • Avanafil
  • Bosutinib
  • Bedaquiline
  • Brexpiprazole
  • Brentuximab Vedotin
  • Bromocriptine
  • Bromfenac
  • Buprenorphine
  • Bufexamac
  • Cabazitaxel
  • Bupropion
  • Calcifediol
  • Cabozantinib
  • Celecoxib
  • Cariprazine
  • Choline Salicylate
  • Ceritinib
  • Clonixin
  • Cilostazol
  • Clorgyline
  • Clopidogrel
  • Cobimetinib
  • Clozapine
  • Cyclobenzaprine
  • Crizotinib
  • Daclatasvir
  • Dabrafenib
  • Delamanid
  • Dasatinib
  • Dexibuprofen
  • Desvenlafaxine
  • Diclofenac
  • Dexketoprofen
  • Digoxin
  • Diflunisal
  • Dipyrone
  • Dipyridamole
  • Dolasetron
  • Docetaxel
  • Donepezil
  • Domperidone
  • Doxorubicin Hydrochloride Liposome
  • Doxorubicin
  • Droxicam
  • Droperidol
  • Enzalutamide
  • Edoxaban
  • Erlotinib
  • Eptifibatide
  • Etodolac
  • Eszopiclone
  • Etoricoxib
  • Etofenamate
  • Felbinac
  • Everolimus
  • Fentanyl
  • Fenoprofen
  • Feprazone
  • Fepradinol
  • Flufenamic Acid
  • Floctafenine
  • Flurbiprofen
  • Fluoxetine
  • Fosaprepitant
  • Fluticasone
  • Hydrocodone
  • Granisetron
  • Ibrutinib
  • Hydroxytryptophan
  • Idelalisib
  • Ibuprofen
  • Iloperidone
  • Ifosfamide
  • Iobenguane I 123
  • Indomethacin
  • Irinotecan
  • Iproniazid
  • Ivacaftor
  • Irinotecan Liposome
  • Ketoconazole
  • Ixabepilone
  • Ketorolac
  • Ketoprofen
  • Levomilnacipran
  • Lapatinib
  • Lornoxicam
  • Lorcaserin
  • Lumiracoxib
  • Loxoprofen
  • Manidipine
  • Macitentan
  • Mefenamic Acid
  • Meclofenamate
  • Meperidine
  • Meloxicam
  • Mifepristone
  • Methylene Blue
  • Mirtazapine
  • Milnacipran
  • Morniflumate
  • Moclobemide
  • Naproxen
  • Nabumetone
  • Nepafenac
  • Naratriptan
  • Nifedipine
  • Nialamide
  • Nilotinib
  • Niflumic Acid
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Oxaprozin
  • Olaparib
  • Oxyphenbutazone
  • Oxycodone
  • Palonosetron
  • Palbociclib
  • Parecoxib
  • Panobinostat
  • Paroxetine
  • Pargyline
  • Phenylbutazone
  • Pazopanib
  • Pimavanserin
  • Piketoprofen
  • Piroxicam
  • Piperaquine
  • Pranoprofen
  • Ponatinib
  • Procarbazine
  • Prasugrel
  • Propyphenazone
  • Proglumetacin
  • Quetiapine
  • Proquazone
  • Reboxetine
  • Rasagiline
  • Retapamulin
  • Regorafenib
  • Rizatriptan
  • Rivaroxaban
  • Romidepsin
  • Rofecoxib
  • Safinamide
  • Ruxolitinib
  • Salmeterol
  • Salicylic Acid
  • Selegiline
  • Salsalate
  • Sildenafil
  • Sibutramine
  • Sodium Salicylate
  • Simeprevir
  • Sulindac
  • Sonidegib
  • Sunitinib
  • Sumatriptan
  • Tacrolimus
  • Suvorexant
  • Tamsulosin
  • Tadalafil
  • Temsirolimus
  • Tapentadol
  • Tiaprofenic Acid
  • Tenoxicam
  • Ticlopidine
  • Ticagrelor
  • Tolfenamic Acid
  • Tirofiban
  • Toloxatone
  • Tolmetin
  • Trabectedin
  • Toremifene
  • Tranylcypromine
  • Tramadol
  • Valdecoxib
  • Trazodone
  • Venlafaxine
  • Vemurafenib
  • Vincristine
  • Vilanterol
  • Vincristine Sulfate Liposome
  • Vilazodone
  • Vorapaxar
  • Vinflunine
  • Ziprasidone
  • Vortioxetine
  • Zolpidem
  • Zolmitriptan

Risk of adverse health effects can be increased if you are taking the following medications while you are in drug therapy with Nefazodone. Be aware of the health risks if you combine:

  • Buspirone
  • Alprazolam
  • Foxglove
  • Cyclosporine
  • Haloperidol
  • Ginkgo
  • Pravastatin
  • Methylprednisolone
  • St John's Wort
  • Ritonavir

In general, it is best to avoid taking other medications if possible while you are on Nefazodone, but if you cannot avoid other medications, make sure your physician is aware that you take them.

Many physicians recommend that you take your dose of Nefazodone with food to combat any stomach upset issues. Consult your doctor if you have questions about combining this medication with foods. Consumption of alcoholic beverages is not advised while you are on this medication due to the way it affects your central nervous system, which can combine with Nefazodone and cause unwanted symptoms. Use of tobacco products should be discussed with your physician who may advise you on ways to stop smoking or using tobacco in any way.

The medical conditions listed below have been known to worsen with use of Nefazodone or to increase the adverse effects on health you may experience. Communicate your full medical history to the doctor prescribing this medication for you, especially if you have:

  • Heart disease
  • Stroke history
  • Dehydration
  • Low volume of blood in your body
  • History of seizures
  • Liver disease
  • Liver function problems
  • Mental illnesses such as mania or manic disorders

Warnings

Expect regular visits to your doctor while you are on this drug and keep all appointments as assigned to you. If you must reschedule, do it as soon as possible to keep a consistent time schedule for monitoring your condition. Your dosage may be adjusted to improve the effectiveness or to relieve side effects depending on how you have been reacting to the drug.

Avoid taking cisapride, astemizole, pimozide and/or terfenadine if you are taking Nefazodone, as these drugs can combine to affect your heart rhythm in a dangerous manner.

The effectiveness of Nefazodone will be seriously compromised if you are taking carbamazepine at the same time. Avoid combining these two drugs and discuss any questions you have about this with your doctor.

One of the most important organs in your body, the liver, may be compromised if you take Nefazodone. Be on the alert and place your caregiver on the alert for any symptoms related to diminished liver function. These include weak, tired feelings, fatigue, stools that are light in color, nausea, yellow skin, yellow eyes, and pain in the abdominal area, urine that is darker than normal and weak muscles. Get in touch with your physician right away if you notice any of these symptoms.

Avoid taking MAO inhibitor type medications such as procarbazine, phenelzine, furazolidone, selegiline and tranylcypromine if you are on this medication as they could cause dangerous health effects when combined. Avoid taking these within 14 days of each other, if possible. If you begin to have convulsions, an extremely elevated body temperature or other serious health problems, get in touch with your doctor and let him know that you have combined these drugs.

You may experience mood swings that will give you an agitated, irritable demeanor or cause you to behave abnormally or in an over-excited way. Some patients may experience an increase or onset of suicidal thoughts or tendencies. If you or your family members or caregivers notice any mood changes or increasing of your depression symptoms, get in touch with your physician immediately.

Central nervous system depressant medications can amplify the side effects that you are at risk for when you're taking Nefazodone. Alcohol is a depressant and should be avoided while you are taking this medication as should any allergy supplements, medications for colds and flu, sedatives, sleeping medications, tranquilizers, pain medicines, narcotics, seizure medications, barbiturates, muscle relaxers or anesthetics. If you are having dental surgery or other surgical procedures during your Nefazodone treatment, let your dentist know you are taking this medicine.

Before you operate tools or machinery or get behind the wheel of a vehicle, be aware that you could have symptoms that affect your alertness and your reflexes while you are taking Nefazodone. Don't put yourself or others in danger by driving or doing other dangerous activities until you know how alert you are when taking this medication.

When rising from a seated or lying position, you may feel dizzy or lightheaded or like you're going to pass out. Rise slowly from these positions and check with your doctor if these symptoms don't go away with time or become worse.

Dry mouth, a condition that is at a high risk when you are taking Nefazodone, can lead to gum disease, tooth decay and fungal infections in your mouth. Consult your dental professional or doctor if you have dry mouth symptoms for longer than 14 days for ways to prevent long-term adverse health effects.

Read and understand all patient information provided to you with your prescription of Nefazodone and ask your doctor or pharmacist if you have any questions. Avoid taking other drugs or health supplements while you are using this medication as they could cause adverse effects on your health.

Storage

Nefazodone should be kept in the original packaging and stored at room temperature away from light, moisture or heat sources. Do not allow Nefazodone to freeze and dispose of it if it does freeze. Store this and other medications safely out of sight and reach of children and pets. Expired or unused doses of Nefazodone should be disposed of safely according to the instructions that your doctor or pharmacist provides you.

Summary

Nefazodone is an anti-depressant medication that elevates the levels of serotonin and norepinephrine found in the central nervous system. Patients with low levels of these two enzymes often suffer from depressed mood symptoms that take over their lives and prevent them from being productive and having relationships with others. It is estimated that over 300 million people in the world suffer from depression, which could be treated with drugs such as Nefazodone.

Depression sufferers are at a high risk of suicidal behaviors and these risks can be increased as a result of taking Nefazodone. Special attention should be paid to any patients on this medication who experience changes in their mood or demeanor. This includes any agitated, irritable behavior or any worsening of depression symptoms. Seek emergency help if you or someone you care for is showing signs of suicidal thoughts.

It is not recommended that patients who have impaired liver function take this medication, as it has been known to cause problems with the liver. Geriatric patients who have age-related diminished liver function should have their dosage adjusted accordingly. Symptoms such as a yellow tinge to the eyes or skin, pale stools, extreme fatigue and heart rhythm changes should be reported to your doctor immediately.

Avoid taking other drugs especially MAO inhibitors and other anti-depressant medications. Do not drink alcohol while taking this medication. Avoid driving and other dangerous activities until you know if this medication will cause you to be dizzy or less responsive than normal. Report any health or mood changes to your doctor immediately.

Women who are pregnant and women who are breastfeeding should not take this medication nor should children under the age of 18. The safety of the patient has not been determined in these age groups nor is this medication known to be effective in the treatment of depression in children. Discuss any concerns with your physician.

Nefazodone takes time to noticeably improve your symptoms, so continue your prescription as directed and keep all appointments for progress monitoring. Your dosage may be adjusted up or down depending on how this medication is working for you and if it is causing any unwanted effects on your health.

However, because of the high risk to liver health, Nefazodone was removed from the US market in 2004 and should no longer be prescribed.