Home Drug Guide Nefazodone Hydrochloride

Drug Guide

Generic Name

Nefazodone Hydrochloride

Brand Names Serzone

Classification

Therapeutic: Antidepressant

Pharmacological: Serotonin antagonist and reuptake inhibitor (SARI)

FDA Approved Indications

  • Major depressive disorder

Mechanism of Action

Nefazodone inhibits the reuptake of serotonin and norepinephrine, and antagonizes certain serotonin receptors, leading to increased serotonergic neurotransmission and antidepressant effects.

Dosage and Administration

Adult: Initial dose: 200 mg two to three times daily. Dose may be increased gradually as needed and tolerated, typically up to 300-600 mg per day in divided doses.

Pediatric: Not approved for pediatric use.

Geriatric: Start at lower dose; monitor closely due to increased sensitivity and potential for adverse effects.

Renal Impairment: Use with caution; dosage adjustments may be necessary.

Hepatic Impairment: Contraindicated in severe hepatic impairment; caution in mild to moderate impairment.

Pharmacokinetics

Absorption: Well-absorbed with oral administration.

Distribution: Extensively distributed; protein binding approximately 99%.

Metabolism: Primarily via hepatic CYP3A4.

Excretion: Metabolites excreted mainly via feces, with some renal excretion.

Half Life: Approximately 2-6 hours; active metabolites may prolong the effect.

Contraindications

  • History of hepatic impairment or active liver disease.
  • Concurrent use of other serotonergic drugs due to risk of serotonin syndrome.

Precautions

  • Hepatic monitoring recommended; may cause hepatotoxicity.
  • Use with caution in patients with underlying cardiac disease, seizure history, or those taking other CNS depressants.
  • Pregnancy/lactation: Use only if clearly needed; advise on potential risks.

Adverse Reactions - Common

  • Dizziness (Frequent)
  • Sedation (Frequent)
  • Dry mouth (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • Hepatotoxicity/liver failure (Rare but serious)
  • Serotonin syndrome (Rare)
  • Orthostatic hypotension (Uncommon)

Drug-Drug Interactions

  • CYP3A4 inhibitors or inducers (e.g., ketoconazole, rifampin) which can alter nefazodone levels.
  • Other serotonergic drugs (e.g., SSRIs, MAOIs) increasing serotonin syndrome risk.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor liver function tests before and periodically during therapy. Assess mental status and substance use.

Diagnoses:

  • Risk of hepatotoxicity
  • Risk for serotonin syndrome

Implementation: Administer with food to reduce gastrointestinal irritation. Start with low doses in elderly.

Evaluation: Observe for improvement in depressive symptoms and monitor for adverse effects.

Patient/Family Teaching

  • Do not use alcohol or other CNS depressants concurrently.
  • Report any signs of liver problems (jaundice, dark urine, abdominal pain).
  • Be aware of symptoms of serotonin syndrome (confusion, hallucinations, rapid heartbeat, changes in blood pressure, fever, loss of coordination).

Special Considerations

Black Box Warnings:

  • Hepatotoxicity leading to severe, sometimes fatal, liver injury. Regular monitoring of liver function is mandatory.

Genetic Factors: None established specific to nefazodone.

Lab Test Interference: None reported.

Overdose Management

Signs/Symptoms: Drowsiness, blood pressure changes, nausea, vomiting, and in severe cases, coma or hepatotoxicity.

Treatment: Supportive care, activated charcoal if ingestion is recent, monitor liver function, and provide symptomatic treatment. There's no specific antidote.

Storage and Handling

Storage: Store at room temperature away from moisture, light, and heat.

Stability: Stable under standard conditions for the duration of the expiration date. Discard if expired or contaminated.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.