Nefazodone



Nefazodone




For a more detailed discussion of this topic, see Nefazodone, Sec. 31.23, p. 3164, in Comprehensive Textbook of Psychiatry, 9th Edition.



Nefazodone (Serzone) is indicated for the treatment of major depression. It is an analog of trazodone (Desyrel). When nefazodone was introduced in 1995, there were expectations that it would become widely used because it did not cause the sexual side effects and sleep disruption associated with the selective serotonin reuptake inhibitors (SSRIs). Although it was devoid of these side effects, it was nevertheless found to produce problematic sedation, nausea, dizziness, and visual disturbances. Consequently, nefazodone was never extensively adopted in clinical practice. This fact, as well as reports of rare cases of sometimes fatal hepatotoxicity, led the original manufacturer to discontinue production of branded nefazodone in 2004. Generic nefazodone remains available in the United States.


Pharmacologic Actions

Nefazodone is rapidly and completely absorbed but is then extensively metabolized so that the bioavailability of active compounds is about 20% of the oral dose. Its half-life is 2 to 4 hours. Steady-state concentrations of nefazodone and its principal active metabolite, hydroxynefazodone, are achieved within 4 to 5 days. Metabolism of nefazodone in elderly persons, especially women, is about half that seen in younger persons, so lowered doses are recommended for elderly persons. An important metabolite of nefazodone is meta-chlorophenylpiperazine (mCPP), which has some serotonergic effects and may cause migraine, anxiety, and weight loss.

Although nefazodone is an inhibitor of serotonin uptake and, more weakly, of norepinephrine reuptake, its antagonism of serotonin 5-HT2A receptors is thought to produce its antianxiety and antidepressant effects. Nefazodone is also a mild antagonist of the α1-adrenergic receptors, which predisposes some persons to orthostatic hypotension but is not sufficiently potent to produce priapism.

Jun 8, 2016 | Posted by in PSYCHIATRY | Comments Off on Nefazodone

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