Nefazodone (Serzone): Uses, Dosage, Side Effects, & Warnings

What Is Nefazodone?

Nefazodone is an oral medication used to treat depression. It is a unique antidepressant, as it shares no resemblance to common antidepressant drug classes; instead, it occupies its own drug class. Nefazodone is thought to affect the action of certain chemicals, such as serotonin and norepinephrine, in the brain.¹

Nefazodone is FDA-approved to treat depression. FDA approval means the drug has undergone rigorous testing and has been shown to provide benefits to patients for its intended use. It is important to note that the brand name version of nefazodone, Serzone, is discontinued in the United States. Only the generic, nefazodone, is available for use.¹

Is Trazodone the Same As Nefazodone?

Trazodone is not the same as nefazodone. Although they are both unique because they are not classified with other common antidepressants, their chemical structures are different. Additionally, trazodone is only thought to inhibit serotonin reuptake, whereas nefazodone is shown to inhibit both serotonin and norepinephrine reuptake.¹

How Does Nefazodone Work?

While nefazodone’s mechanism of action to treat depression symptoms isn’t entirely understood, it is thought that it affects the activity of serotonin and norepinephrine in the brain, helping improve mood. Chemical imbalances in the brain may be the cause of certain depression disorders.¹

What Is Nefazodone Used to Treat?

Nefazodone is FDA-approved to treat depression. FDA approval means the drug has undergone rigorous testing and has been shown to provide benefits to patients for its intended use. Due to its adverse effects, nefazodone is typically prescribed after one or more depression treatment options have not been effective enough.

Sometimes, prescribers may choose a medication for a non-FDA-approved use if they believe it may offer a specific benefit to a patient, which is called an “off-label” use. There are no off-label uses for nefazodone.¹

Common Side Effects of Nefazodone

The most common nefazodone side effects patients notice include drowsiness, dry mouth, nausea, and dizziness. If symptoms continue or worsen, medical care may be needed, and you should contact your prescriber or pharmacist immediately.

Common side effects of nefazodone include:¹

• Headache
• Drowsiness
• Dizziness
• Dry mouth
• Nausea
• Confusion
• Constipation
• Fatigue
• Vision problems

*All medications, including nefazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor and pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Nefazodone

In some cases, patients experience more serious side effects while using nefazodone. The likelihood of liver problems increases while taking nefazodone, and your prescriber should take into account any history of liver problems before prescribing nefazodone. Additionally, abdominal issues and skin reactions have been observed in some patients taking nefazodone. Please contact your prescriber and pharmacist if any of these serious side effects occur.¹

Serious side effects of nefazodone include:¹

• Increased risk of suicidal ideation
• Liver problems
• Urinary tract infections
• Loss of appetite that lasts several days or longer
• Confusion, impaired judgment and impaired motor skills
• Allergic reactions

*All medications, including nefazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor and pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Nefazodone Warnings & Precautions

All medications have warnings and precautions, nefazodone included. Those who are allergic to nefazodone, or trazodone should not take this medication. Additionally, you should not take nefazodone if you have a previous history of liver problems. Medical attention may be required for people taking nefazodone under these conditions.¹ Make sure to talk with your healthcare professional about your entire health history to ensure that nefazodone is safe for you to take.

You may need to avoid or take precautions with taking nefazodone if you:¹

• Have an allergic reaction: Avoid taking nefazodone if you have had an allergic reaction to it or a related medication, trazodone.
• Are taking certain medications: Examples of medications that may have harmful interactions with the nefazodone – Seldane (terfenadine), an antihistamine; Hismanal (astemizole), an antihistamine; Propulsid (cisapride), used for heartburn; Halcion (triazolam), used for insomnia; Orap (pimozide), used to treat Tourette’s syndrome; or Tegretol (carbamazepine), used to control seizures.
• Currently have liver problems: Having an active liver condition or a history of liver problems can increase risks and worsen their condition.
• Are taking or have taken monoamine oxidase inhibitors (MAOIs): Avoid taking nefazodone within 14 days (MAOIs), such as Nardil or Parnate, due to harmful interactions between these medications.
• Have a history of mental health problems: It’s possible that taking nefazodone can worsen existing mental health problems, including thoughts of suicide and manic episodes.

Nefazodone Dosages for FDA-Approved Treatment

Dosing for nefazodone is done on an individual basis. Each person may receive a different dose based on a variety of factors, such as the person’s age or the condition being treated. This is done at the discretion of the prescriber. It is important to note that the severity of symptoms is NOT related to dosage.¹

For nefazodone, the recommended starting dose for most people is 200 milligrams (mg) per day, taken in two separate doses each day. The dosing range for depression treatment is 300 mg to 600 mg a day, with the daily doses split into two daily doses. Initial or maintenance dosing may need to be adjusted based on patient-specific factors.¹

Nefazodone Forms & Strengths

There are varying strengths of nefazodone, from 50 mg to 25 0mg tablets. The most appropriate strength for an individual is subjective. Your prescriber will determine which strength is best for each person. The only dosage form of nefazodone is an oral tablet.

Additionally, there are no extended, delayed, or sustained release options for nefazodone. Nefazodone can take several weeks to reach its full effect.¹

Nefazodone is available in the following forms and strengths:¹

• 50 milligrams (mg) oral tablet
• 100 mg oral tablet
• 150 mg oral tablet
• 200 mg oral tablet
• 250 mg oral tablet

How to Take Nefazodone

The only available dosage form for nefazodone is an oral tablet. Take nefazodone at the same time every day. It may be taken with or without food. It is important to take nefazodone exactly as prescribed by your prescriber and pharmacist.¹

What Happens If I Miss a Dose of Nefazodone?

If a dose of nefazodone is missed, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with the dosing regimen described by your prescriber. Never take two doses at the same time.¹

If you have missed a dose and aren’t sure if you should take it, contact your pharmacist or healthcare professional.

Can You Overdose on Nefazodone?

Yes, you can overdose on nefazodone. If an overdose is suspected, seek immediate medical care. Overdoses on nefazodone can be caused by taking more than your prescribed dose or using it with alcohol or other substances.¹

What Should You Do If You Take Too Much Nefazodone?

If someone takes too much nefazodone, call your prescriber or pharmacist for medical help immediately. Symptoms of an overdose include nausea and vomiting. Additionally, the poison control center (1-800-222-1222) or 9-1-1 can assist if an overdose is suspected. If waiting for medical assistance to arrive, ensure airways are cleared and have a licensed professional perform CPR if necessary and available.¹

What to Avoid When Taking Nefazodone

Nefazodone can have potentially harmful interactions with certain substances. It is important to tell your prescriber and pharmacist all the medications you are currently taking, including over-the-counter medications, vitamins, supplements, etc. These substances below may affect the way nefazodone works in your body.¹

Substances you should avoid while taking nefazodone include:¹

• Alcohol: Avoid alcoholic beverages while on nefazodone; serious complications can occur.
• Are taking certain medications: Examples of medications that may have harmful interactions with the nefazodone – Seldane (terfenadine), an antihistamine; Hismanal (astemizole), an antihistamine; Propulsid (cisapride), used for heartburn; Halcion (triazolam), used for insomnia; Orap (pimozide), used to treat Tourette’s syndrome; or Tegretol (carbamazepine), used to control seizures.
• Are taking or have taken monoamine oxidase inhibitors (MAOIs): Avoid taking nefazodone within 14 days (MAOIs), such as Nardil or Parnate, due to harmful interactions between these medications.

This is not a comprehensive list of the possible interactions with nefazodone. You should talk with your healthcare provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting nefazodone.

Nefazodone Antidepressant Discontinuation

Potentially harmful complications may arise if nefazodone is abruptly discontinued. Do not discontinue nefazodone until you have discussed it with your prescriber. Antidepressant discontinuation syndrome (ADS) is possible. This can occur when people abruptly stop or drastically reduce their dosage of an antidepressant. Symptoms of ADS include dizziness, fatigue, and headache. It is important to discuss with your prescriber a plan to taper your medication.¹

How to Get a Prescription for Nefazodone

Nefazodone is available only by prescription. A psychiatrist may prescribe nefazodone for use to treat depression. A psychiatric evaluation may be necessary for a diagnosis of depression if the diagnosis has not already been determined. Other treatment options may be provided before nefazodone is prescribed.¹

How Much Does Nefazodone Cost?

Discounts and coupons for nefazodone can lower the price and are available online. The retail price for 60 tablets of 100 mg nefazodone is about $135, ranging from $85-200 on various online pharmacy sites for the same number of tablets. Additionally, insurance may cover a portion of the cost of nefazodone, so you may be able to call your insurance company to get discounted prices.²

What Can I Take Instead of Nefazodone?

There are many alternatives for nefazodone. Being an antidepressant, there are other medications on the market to treat varying levels of depression. The increased chance of liver toxicity with nefazodone may be a reason an alternative medication may be used.¹

Examples of alternatives include:

• Wellbutrin (bupropion)
• Cymbalta (duloxetine)

Questions to Ask Your Healthcare Provider About Nefazodone

Nefazodone is used to treat major depression. If you think you may benefit from nefazodone, speak to your doctor, pharmacist, psychiatrist, or therapist. Additionally, online psychiatry services are available for those who may need to change prescribers or have difficulty getting transport to their provider.

Questions to ask your care team about nefazodone include:

• How does nefazodone work to treat my condition?
• How safe is nefazodone? What are the potential risks and benefits of taking nefazodone?
• How long will it take to feel results after starting nefazodone?
• Is nefazodone a long-term treatment for depression?
• How might nefazodone interact with other medications I am on?
• Will I need to alter my lifestyle if I begin taking nefazodone?
• How will nefazodone affect other areas of my life?
• Is nefazodone recommended as a first option after being diagnosed with depression?
• Can other antidepressants be taken in combination with nefazodone?
• Are there any lifestyle changes or precautions I should take while using nefazodone?
• Are there any alternative depression treatments I should consider that may work better for me?