Classifications: psychotherapeutic agent; antidepressant; selective serotonin reuptake inhibitor (ssri); Therapeutic: antidepressant; ssri
Prototype: Fluoxetine HCl
Pregnancy Category: C
50 mg, 100 mg, 150 mg, 200 mg, 250 mg tablets
Antidepressant with a dual mechanism of action. Inhibits neuronal serotonin (5-HT1) reuptake and also possesses 5-HT2 antagonist properties.
Antidepressant effects with minimal cardiovascular effects, fewer anticholinergic effects, less sedation, and less sexual
dysfunction than other antidepressants.
Treatment of depression.
Hypersensitivity to nefazodone or alcohol; hepatic disease, hepatitis, jaundice; MAOI therapy; mania; severe restlessness,
suicidal ideation; surgery, neonates; pregnancy (category C), lactation.
Older adults, women of childbearing age; history of seizure disorders, seizures; renal or hepatic impairment; recent MI,
unstable cardiac disease; hypotension; angina, stroke, hypovolemia, dehydration, bipolar disorder; history of mania; ECT
therapy. Safety and efficacy in children <18 y are not established.
Route & Dosage
Adult: PO 50100 mg b.i.d., may need to increase up to 300600 mg/d in 23 divided doses
Geriatric: PO Start with 50 mg b.i.d.
- Do not give within 14 d of discontinuation of an MAO inhibitor.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)Body as a Whole:
Anaphylactic reactions, angioedema. CNS: Headache, dizziness, drowsiness,
asthenia, tremor, insomnia
, agitation, anxiety. GI:
Dry mouth, constipation
, nausea, liver toxicity. Special Senses:
Visual disturbances, blurred vision, scotomata. Endocrine:
Galactorrheas, gynecomastia, serotonin syndrome
. Skin: Stevens-Johnson syndrome, liver failure.
May cause serotonin syndrome
(see Appendix F) with maoi
s or ssri
s; may increase plasma levels of some benzodiazepines
, including alprazolam
May decrease plasma levels and effects of propranolol.
May increase levels and toxicity of buspirone, carbamazepine, cilostazol, digoxin;
reports of QTc prolongation and ventricular arrhythmias with pimozide;
increased risk of rhabdomyolysis with lovastatin, simvastatin;
increased risk of ergotamine
toxicity with dihydroergotamine, ergotamine. Herbal: St. John's wort
may cause serotonin
1 wk. Peak:
35 wk. Metabolism:
In liver to at least two active metabolites. Half-Life:
Nefazodone 3.5 h, metabolites 233 h.
Assessment & Drug Effects
- Monitor for worsening of depression or emergence of suicidal ideation.
- Evaluate concurrent drugs for possible interactions.
- Monitor patients with a history of seizures for increased activity.
- Assess safety, as dizziness and drowsiness are common adverse effects.
- Lab tests: Monitor periodically liver function and CBC during long-term therapy.
Patient & Family Education
- Be aware that significant improvement in mood may not occur for several weeks following initiation of therapy.
- Do not drive or engage in potentially hazardous activities until response to the drug is known.
- Report changes in visual acuity.