nefazadone

[50960]

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How many are using Serzone now? I use it sometimes with pre-lab work to r/o liver probs because it can be so effective for depression with insomnia, PTSD etc. Anyone else besides Sazi who I know uses it??

 

[Anasazi23]

Don't get me wrong. It's way down on my repetoire of agents to use for depression. The brand isn't even available anymore either, so it's not always easy for the patient to get. Generally speaking, although the risk for serzone induced hepatic failure is something like 300,00 patient/years, we should try and avoid big black boxes about liver failure if there are other comparable agents that have proven about as efficacious. If it was still wonderfully effective compared to similar agents, many more docs would be using it. As we know, LFTs are not frequently not useful in monitoring hepatic failure. One must observe the clinical signs and symptoms of this process. This is also evident in Hepatitis. Generally with Serzone, if you don't get the hepatic effects early in the treatment, you have a very low liklihood of it happening at all.

But, I have used it sometimes - either of for people already on it that were doing well, people that were on it years ago and seemed to have a beneficial effect, or when other agents have failed. When it first came out, it was used with some success in the agitated geriatric population.

As with all things in medicine, documentation is the key.

 

[50960]

What would you consider a similar, safer medication? Remeron?

 

[Poety]

What would you consider a similar, safer medication? Remeron?

Good luck getting someone young to comply with that one! The weight gain is significant. I would only use that if they had cachexia with the depression compounded with insomnia. Its not the greatest drug out there.

Sorry.... I butted in ....


leaving now....


bye 😳

 

[Psyclops]

Mind if I join? I've only seen remeron ordered at HS. Which seems to mitigate the sedative effects. Is the weight gain due to a gain in appetite or does it affect metabolism?

 

[50960]

Histaminergic antagonism. I have used it in low dose (7.5 mg qhs) for quite a few people to help with sleep, and wt gain is minimal or corrects if it is only used for a month or so while you are titrating up another antidepressant.

 

[Poety]

Histaminergic antagonism. I have used it in low dose (7.5 mg qhs) for quite a few people to help with sleep, and wt gain is minimal or corrects if it is only used for a month or so while you are titrating up another antidepressant.

Why use it at all psisci? I'd prefer a lunesta or ambien. I understand the sleep thing, but I'd only use that for refractory insomnia after already having them on a sleep aid of some sort. Trazadone would be a better bet though, no?


leaving again..



for good....



bye 😳

 

[Psyclops]

Why use it at all psisci? I'd prefer a lunesta or ambien. I understand the sleep thing, but I'd only use that for refractory insomnia after already having them on a sleep aid of some sort. Trazadone would be a better bet though, no?

I think the reason you would use it, like psisci said, would be to get a faster result while the SSRI titirates up, right? Or am I wrong? I thought mirtazipine had a faster response rate. But then gain I can't remember for certain.

 

[Poety]

I think the reason you would use it, like psisci said, would be to get a faster result while the SSRI titirates up, right? Or am I wrong? I thought mirtazipine had a faster response rate. But then gain I can't remember for certain.

Am new grad...


will...not... respond................................



could use an ssri with trazadone.


THATS IT, THATS ALL IM SAYING. Leave me alone, I'm gardening 😛 😎

 

[50960]

Trazadone is good and I use it most often. However for those who have failed trazadone and have significant SA issues I prefer to stay away from Ambien, Lunesta etc. Also, the docs who prescribe for me feel the same way, but about almost any pt....fear of sleepers.

 

[Milo]

Trazadone is good and I use it most often. However for those who have failed trazadone and have significant SA issues I prefer to stay away from Ambien, Lunesta etc. Also, the docs who prescribe for me feel the same way, but about almost any pt....fear of sleepers.

I don't know...

- A branded med that has been pulled off the market BEFORE the patent expires?

- Banned in several countries

- At least 20 deaths associated from liver failure.

And you have a fear of sleepers? Me, I fear the lawyers.

 

[Poety]

I don't know...

- A branded med that has been pulled off the market BEFORE the patent expires?

- Banned in several countries

- At least 20 deaths associated from liver failure.

And you have a fear of sleepers? Me, I fear the lawyers.

desyrl is off the market? when did that happen?

 

[sdn1977]

desyrl is off the market? when did that happen?

No no no...not Desyrel...Serzone was pulled off the US market by Bristol-Meyers Squibb. That was after it & the generic was pulled from the Candadian market. The corporate fear was the lawsuits pending due to the liver failure episodes which do not appear to have a predictable occurrance.

Desyrel is still on the market, both branded and generic.

 

[Poety]

No no no...not Desyrel...Serzone was pulled off the US market by Bristol-Meyers Squibb. That was after it & the generic was pulled from the Candadian market. The corporate fear was the lawsuits pending due to the liver failure episodes which do not appear to have a predictable occurrance.

Desyrel is still on the market, both branded and generic.

Thank God, I was REALLY ABOUT TO FREAK OUT about knowing ANYTHING before internship! I was like, uhhh oh no, now I'll be ordering meds that aren't even available

 

[silvergirl]

I just thought I'd share my own personal experiences with Nefazodone. I took 200 mg daily for 6 years during adolescence for Major Depression and PTSD, after having had a bad reaction to Prozac (which was the doctor's initial choice of course).

When Serzone was pulled from the market, I got nervous and weaned off the Serzone, trying various other meds and combinations -- none of which worked well, and all of which gave me unpleasant side effects. I tried Wellbutrin with varying doses (got agitation and insomnia), tried SSRIs and had complete loss of libido, combined the two and just had agitation AND loss of libido. The depression never fully lifted during that whole time. Eventually, after two years of misery, my doc said we could try the serzone again since it worked so well before. Six months later, LFTs still totally normal, I feel myself again. 😉

I probably wouldn't ever start a patient on Serzone, but if it's the only thing that works, you might as well try it.

 

[50960]

Why would you NEVER start a pt on this. Sazi will never come out to support me, but I know he feels as I do that the FDA is very over reactive and political. Nefazadone can be a very useful med, and has very few adequate replacements. The risks are there as with alot of meds. I am afraid of lawyers as well, but we have to at least try to help our pts with the limited drugs we have???...right?

 

[Anasazi23]

I agree that the FDA has a lot of crap underneath it that isn't scientifically based. But, one must consider the worst scenario in every prescription written. If the person is antidepressant naive, and God-forbid they do go into fulminant hepatic failure (you'd see the signs anyway), how would you defend yourself in court?

It simply isn't a first line treatment, just as Thorazine or Clozapine is not a first line treatment. Do I start patients on Thorazine or Clozapine as a first choice? Sometimes. But that's in rare and exceptional circumstances (usually). The same would have to go for Serzone. While a lot of the fervor was hype, there is a real danger of this side effect.

Other issues, such as the weight gain, are real and patients complain about it. Silvergirl's vignette is very typical of a patient involved with Serzone. Did poorly, responded well to Serzone, taken off for whatever reason, failed on other ADs, again responded with a rechallenge of Serzone.

Remeron does respond similarly and has the inverse dose/fatigue dose phenomenon, so there are ways to manipulate it to your doing. It is a safer drug than Serzone generally speaking. It also has other, potentially beneficial side effects as well. If a person was taking Serzone, and doesn't want to be on it, I would likely try other ADs with augmentation strategies - depending on their individual presenting symptoms (ruminating thoughts, hypersomnia, etc).

A lot of what we do is not scientifically based - i.e. defensive medicine. All branches of medicine are victims of corporate legal-infused medicine practice. It's not right, but it's our reality for now. I'll say it again - you can get away with a lot with good documentation.