nefazodone

an antidepressant, used as the hydrochloride salt.

nefazodone

(neff-a-zoe-done) ,

Serzone

(trade name) Pregnancy Category: C

Indications

Action

Pharmacokinetics

Time/action profile (antidepressant action)

ROUTE	ONSET	PEAK	DURATION
PO	days–wk	several wk	unknown

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• suicidal thoughts (life-threatening)
• dizziness (most frequent)
• insomnia (most frequent)
• somnolence (most frequent)
• agitation
• confusion
• weakness

Ear, Eye, Nose, Throat

• abnormal vision
• blurred vision
• eye pain
• tinnitus

Respiratory

• dyspnea

Cardiovascular

• bradycardia
• hypotension

Gastrointestinal

• hepatotoxicity (life-threatening)
• constipation (most frequent)
• dry mouth (most frequent)
• nausea (most frequent)
• gastroenteritis

Genitourinary

• erectile dysfunction

Dermatologic

• rash

Hematologic

• decreased hematocrit

Interactions

Drug-Drug interaction

Serious, potentially fatal reactions may occur during concurrent use withMAO inhibitors(do not use concurrently or within 2 wk of MAO inhibitors; discontinue nefazodone at least 14 days before starting MAO inhibitor therapy).↑ CNS depression with other CNS depressants including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.May ↑ blood levels and effects of alprazolam or triazolam.May ↑ serum digoxin levels.Additive hypotension may occur with antihypertensives, nitrates, or acute ingestion of alcohol.May ↑ risk of myopathy with HMG-CoA reductase inhibitors.↓ antidepressant action with concomitant use of carbamazepine.May ↓ clearance of haloperidol, so haloperidol dose may need to be ↓.↑ risk of serotonin syndrome with St. John’s wort and SAMe.Kava-kava, valerian, or chamomile can ↑ CNS depression.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Assess mental status (orientation, mood, behavior) frequently. Inform health care professional if patient demonstrates significant increase in anxiety, nervousness, or insomnia.
• Assess suicidal tendencies, especially in early therapy. Restrict amount of drug available to patient.
• Monitor BP and pulse before and periodically during therapy.
• Monitor liver function tests prior to and routinely during therapy. Obtain LFTs at first sign of hepatic dysfunction (nausea, vomiting, abdominal pain, fatigue, anorexia, dark urine).
• Assess for sexual dysfunction throughout treatment.
• Lab Test Considerations: May cause decrease in hematocrit and leukopenia.
  • Monitor liver function periodically. If serum AST or ALT levels are >3 times the upper limit of normal discontinue nefazodone.
  • May also cause hypercholesterolemia and hypoglycemia.

Potential Nursing Diagnoses

Ineffective coping (Indications)
Risk for injury (Side Effects)

Implementation

• Do not confuse Serzone (nefazodone) with Seroquel (quetiapine).
• Discontinue nefazodone prior to elective surgery to prevent potential interactions with general anesthesia.
• Oral: Administer doses twice daily.

Patient/Family Teaching

• Instruct patient to take medication as directed. Several weeks may be required to obtain a full antidepressant response. Once response is obtained, therapy should be continued for at least 6 mo. If a dose is missed, take as soon as possible unless almost time for next dose. Do not double doses.
• May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.
• Advise patient to make position changes slowly to minimize orthostatic hypotension.
• Encourage patient and family to be alert for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, worsening of depression and suicidal ideation, especially during early antidepressant therapy. Assess symptoms on a day-to-day basis as changes may be abrupt. If these symptoms occur, notify health care professional.
• Caution patient to avoid taking alcohol or other CNS depressant drugs during therapy and not to take other prescription, OTC medications, or herbal products without consulting health care professional.
• Advise patient to notify health care professional immediately if signs of liver dysfunction (jaundice, anorexia, GI complaints, malaise, dark urine) occur.
• Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth. If dry mouth persists for more than 2 wk, consult health care professional regarding use of saliva substitute.
• Instruct patient to notify health care professional of signs of allergy (rash, hives) or if agitation, blurred or other changes in vision, confusion, dizziness, unsteadiness, difficult or frequent urination, difficulty concentrating, or memory problems occur.
• Instruct female patient to inform health care professional if pregnancy is planned or suspected or if breast feeding.
• Emphasize the importance of follow-up examinations to monitor progress.

Evaluation/Desired Outcomes

• Increased sense of well-being.
  • Renewed interest in surroundings. May require several weeks of therapy to obtain full response. Need for therapy should be periodically reassessed. Therapy is usually continued for 6 mo or more.