Nefazodone

About Nefazodone

How nefazodone works in depression is unknown, as with other antidepressants; it blocks serotonin 5-HT2 receptors, and in preclinical studies it slowed the reuptake of serotonin and norepinephrine. The label covers the treatment of depression, but because of the risk of liver failure it asks prescribers to weigh that risk and says that in many cases other drugs should be tried first. Adults usually start at 200 mg a day split into two doses, raised by 100 to 200 mg a day at intervals of at least a week (effective doses in its studies were generally 300 to 600 mg a day); older or debilitated adults start at 100 mg a day in two doses. Several weeks may pass before the full effect, and it is not approved for children.

One boxed warning covers liver failure: cases leading to a liver transplant or death have been reported, and the warnings section says they generally began between 2 weeks and 6 months into treatment. It is ordinarily not started in people with active liver disease or raised liver enzymes. It is stopped if signs of liver failure appear, or if AST or ALT reaches three times the upper limit of normal, and it is not restarted after liver injury; patients report yellowing of the skin or eyes, loss of appetite, stomach complaints or feeling unwell at once. The other is the antidepressant warning: in short-term studies, antidepressants raised the risk of suicidal thoughts and behavior in children, teenagers and young adults, so anyone starting it is watched closely for worsening, suicidal thinking or unusual changes in behavior. The warnings also call for screening for bipolar disorder and cover angle-closure glaucoma and low sodium. Sleepiness, dry mouth, nausea, dizziness, constipation, weakness, lightheadedness, blurred or abnormal vision and confusion were the most common side effects.

Nefazodone slows CYP3A4, a liver enzyme that clears many drugs. It must not be taken with terfenadine, astemizole, cisapride, pimozide or carbamazepine, or by anyone allergic to it or to other phenylpiperazine antidepressants; the contraindications also say triazolam should be avoided with it for most patients, including older adults, and the label calls for halving the starting dose of alprazolam. It is not used within 14 days after stopping an MAO inhibitor, and at least 7 days pass after stopping it before an MAO inhibitor is started. Rhabdomyolysis, a serious breakdown of muscle, has been reported rarely with simvastatin or lovastatin. The label includes a Medication Guide on antidepressants, depression and suicidal thoughts.

Taking Nefazodone

How to take it

Twice a day, with or without food, at the same times each day. Keep taking it as prescribed even after you feel better, since several weeks may pass before the full effect.

If you miss a dose

The patient leaflet in the label says to skip a missed dose and continue with the regular schedule. Never take two doses at the same time.

Storage

At room temperature, 68°F to 77°F (20°C to 25°C), in the container it came in, tightly closed and out of reach of children. Do not flush unused tablets; use a medicine take-back program.

Interactions to know about

Do not take it with pimozide, carbamazepine or cisapride, or within 14 days after an MAO inhibitor; wait at least 7 days after stopping it before starting one. Triazolam is avoided for most people and alprazolam doses are lowered. With simvastatin, lovastatin or atorvastatin the label recommends adjusting the statin dose, while pravastatin and fluvastatin should not need adjusting. Avoid alcohol.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nefazodone differs from pharmacy to pharmacy

With Serzone discontinued, every fill is a generic, so quotes differ by what each pharmacy pays and the markup and dispensing fee it adds. A pharmacy that does not keep nefazodone on hand may need to order it, which can delay the first fill.

It is taken twice a day, so a month of one tablet per dose is 60 tablets, and the dose is raised in steps at least a week apart, which can mean several small fills, each with its own fee, before the dose is settled. The 50 mg tablets come in bottles of 100 and the other strengths in bottles of 60.

Ways to pay less for Nefazodone without insurance

• Ask whether nefazodone is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Confirm the pharmacy has your strength in stock, or can order it, before the prescription is sent.
• Check that each dose is written as one tablet of the right strength rather than several smaller tablets.
• Once your dose is settled, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nefazodone

1. 1.Which liver symptoms mean I should call right away, and will my liver be tested?
2. 2.Do any of my medicines, such as a statin, a sleeping pill or an anxiety medicine, interact with it?
3. 3.How long will it take to work, and what should I do if my mood or thoughts get worse?
4. 4.How long must I wait when switching from or to another antidepressant?

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