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Doctors' Answers to "Frequently Asked Questions" - Serzone
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Question: I would like to stop taking serzone, I take 200 mg daily.
I tried to stop once before by cutting down the dose weekly.
I was down to 50 mg daily and experienced a horrible migraine.
Was the migrain caused by my reducing the serzone, and could
I use the sample pack and reverse the dosage, starting with
200 mg til gone and going to 150 mg and so one til I am out of
50 mg? I definately don't want to experience another migrain./
Thank you for your answer, and could you please email my answer
to my email address at firstname.lastname@example.org as I will forget
to check here for an answer.
Thank you, Cheryl
Answer: Tapering is what is recommended if you experience the withdrawal syndrome, which is what this probably was rather than a classic migraine.
Question: I'm a 16 year old female and my doctor has recently put me on Serzone, for depression and panic disorder. I was wondering if the drug in any way conflicts with the birth control pill. He didn't seem to think so but I want to know so that I can protect myself properly. Thank you.
Answer: No. But, it can affect sex drive and orgasmic ability.
Question: RE: Is the anti-depressant Serzene in the same serotonin family as Zoloft and Prozac? I have heard the SSRI anti-depressants are the best, but I already have diminished sex drive. I'm afraid I will be more depressed if I take Zoloft, as it will even lower my sex drive. It can't get much lower! Thanks
Answer: Serzone is in a different class and often helps sexually. Also, sometimes taking Buspar concurrently helps those with severe dysfunction on Zoloft and the like.
Question: I am about to start taking Serzone and I have a question concerning drinking alcohol with this drug. Am I going to mess up the supposed treatment, and is this bad to combine?
Answer: A couple a day is probably ok, but alcohol is a depressant and will make your underlying depression more severe. I would recommend taking it for a month or so without alcohol and seeing the results off alcohol. Then you can judge for yourself as to the difference.
Question: Due to excessive weight gain, fatigue and still feeling depressed on 30mg of Paxil my doctor switched me to Serzone last week. After a day or two on the Serzone I began getting extremely thirsty and having stomach cramps assosiated with constant diereah. Still very depressed. Will these symptoms alleviate with time? Could the Serxone be the source of these symptoms?
Answer: Probably persist, hard to know if it is the Serzone, probably not, but you will need time to tell. Might be a withdrawal syndrome from the Paxil.
Question: I've been researching the antidepressant medication nefazodone (sezone), and I've found two articles (see National Library of Medicine website) published in 1999 describing several instances of acute liver failure associated with its use. One of the articles recommends routine liver chemistries before and during the administration of serzone therapy. Have subsequent studies or peer reviews supported these findings and recommendations?
You can find the articles at: http://188.8.131.52/cgi-bin/VERSION_B/IGM-client?10166+records+1
Answer: This is not currently recommended by the FDA that I am aware of, nor do most physicians check the liver functions. You could get the company's input from their scientific department, they will usually answer consumer's questions, but sometimes only to an md, depending on the company. That is BristolMyersSquibb 800-468-7746.
Question: I would like to know if there are any dangers in taking 200mg a day of Serzone and @20mg of Valium per day at the same time?
One Dr. prescribed Serzone for Depression/Anxiety and another Dr. prescribed Valium for the anxety/insomnia. I want to make
sure this combination is not toxic.
Answer: Not usually.
Question: I have been taking Serzone for three weeks, and am very alarmed to have gained 8 pounds. I am 5'6" and have weighed just above 120 for years. I wonder whether the weight gain is temporary, and what casused it (i.e. metabolic change, water retention?), as my eating and exercise habits have not changed. If it doesn't go away, I will stop taking the drug are there alternatives without the weight gain? I was on Wellbutrin for two months with no side effects, but no anti-depressant effects, either. Thank you!
Answer: About 30% of patients on Serzone gain weight, 20% lose weight and 50% stay the same. This is an extraordinary amount to gain in three weeks. I'd discuss it with your md.
Question: I've been taking serzone since 1994. The depression is not nearly as bad but I still don't feel 100%. Does the body build up a resistance to anti-depression drugs?
Answer: Not usually, but it is usually fairly easy to increase the dosage or combine it with other classes of drugs. Serzone is usually started at 100 mg twice a day and increased up to 400 mg twice a day watching for side effects and effectiveness. Some use higher dosages than this without any appreciable problem.
Question: Does Serzone aggravate interstitial cystitis? Also, what cough, cold or allergy medicines (benedryl, sudafed) can safely be taken with Serzone?
Answer: I'm not aware of an interaction with Serzone. There don't appear to be any particular drug interactions with Serzone. Other antidepressants need to be watched, but not usually a problem.
Question: i started taking serzone at a low dosage aug 10. By Aug. 17
Iwas on 300 mg. for 10 wks. Without the greatest results I
was raised to 450 mg.and have been on that dosage for 5 more wks. The zanax is for insomnia which I still suffer from. Every so often I awake very nervous and jittery.HELP
Answer: Probably still the Serzone, if you are prone to this it will persist especially at this dosage.
Question: I am a 29 yr old mother of two boys (9 & 2 yrs) and recently found out I am pregnant. (I am 7 weeks along at present)
I had been on serzone for about six months for an eating disorder (anorexia-with bulimic trates) and for depression. I stopped the serzone the minute I found out I was pregnant. My first question is, can abruptly stopping this medication cause a "mental crash" so to speak? (for days I was a mess, up & down emotionally) This has passed.
My doctor seems skeptical about my taking the serzone while pregnant. Stating if I absolutely need it the benefits may out weigh the risks, but.......it would be best if I could get by without. This leads to my second question, What are the risks of taking this medication while pregnant and would you also advise against it? If so, then what alternatives are there, I have tried prozac & zoloft and had side effects which made them not work for me. (before pregnancy)
It is strange, I never realized how much this medication was REALLY helping me until I stopped it.
I am having a hard time with morning sickness and feeling very ill which makes the whole dilema harder for me.......trying to eat healthy but then physically regretting it.......adding the eating disorder thoughts and I'm afraid I'll be a mess soon. I don't fear starving myself while I'm pregnant but I'm having a hard time functioning in other ways........job, stress, emotions, fatigue.....keeping up with daily responsibilities, etc.
please any advice I would be so thankful for,
Answer: The withdrawal syndrome varies, but generally is headache, nausea, diarrhea and generalized complaints-much like the flu. So certainly possible that you are having withdrawal symptoms. I don't think there is much advantage of one of the other antidepressants vis a vis your pregnancy. There was a recent review of this issue in JAMA, suffice to say that it was non-conclusive but, there do not appear to be major fetal abnormalities with any of them. There are some indications of small fetal size etc. It is rated as a Class C drug-there were no fetal abnormalites in animal studies, but there was an increase in fetal death.
Question: I am weaning off klonopin and am going on serzone. I went off 1/2mg.klonopin in 3 weeks and am taking 225mg of serzone a day. For the last 2 days I have had upset stomach, decreased appetite,dirrhea, lightheadedness and dizziness. Is this normal. Should I do anything different?
Answer: Hard to know if this is withdrawal of the klonopin or side effect of the serzone. If you cut back the serzone a couple of days you would know. Then try to advance the dosage slowly and see if you develop more side effects.
Question: I AM CONSIDERING ASKING MY DR. TO CHANGE MY SERZONE TO REMERON DUE TO SERZONE`S SIDE EFFECT OF DECREASING LIBIDO. HOWEVER I DON`T WANT TO CHANGE IF REMERON ALSO CAUSES DECREASED LIBIDO. CAN YOU TELL ME IF IT DOES?
Answer: Probably will, but you will need to see. Celexa might be an option.
Question: I took Prozac for 7 years, then I took myself off of it. The depression came back. My doctor had me try paxcil 20's I did not like the lack of sensation with having sex. Doctor now wants me to try serzone. My question is, what dose should I start out with, she was very vague with me about dosage. I work afternoons and don't usually get home till 1 in the morning. I always sit down and "unwind" with two bottles of beer. Been doing this for going on 30years. My question is, will this interfere with taking Serzone? Thank you very much for taking my question, I'll be waiting to hear from you. Mike Ennis
Answer: Won't interfere with the Serzone, but the alcohol is probably contributing to your depression. It is a depressant. Usually we urest Serzone at 100 mg once a day for a few days then 100 mg twice a day for a week then 150 mg twice a day. This is the usual starting dosage depending on your weight. But, can be increased every 3-4 weeks to 250mg twice a day under physician control.
Question: I was diagnosed with FMS two yrs ago. The treatment of Elavil has substantially improved life in re: to pain and sleep. The side effects (which have remained constant from the outset) have become almost unmanagable. Blacking out when I stand, esp. when exerting myself physically, weight gain which is steadily increasing even with good diet and exercise, sexual dysfunction, etc. Serzone was recommended as a substitute but I am terrified about losing the pain control. Can Serzone be used effectively to treat this illness? Is there a better choice? The side effects of Elavil when I first took it were three weeks of bleary-eyed waking dream. Will Serzone have similar effects when I start taking it? Thank you for your time. Tara Bird
Answer: Serzone belongs to a complete different class of drugs. Elavil is a tricyclic and is used to deepen your sleep. Fibromyalgia is characterized by low levels of Stage IV sleep(the deepest one of the four) and it is thought that some of the pain/stiffness improves with more Stage IV sleep. Serzone is not a tricyclic but is used in depression. It does not generally add to Stage IV sleep and not generally used in pain control. But, an excellent antidepressant and generally less sexual effects. Unfortunately, there is no good choice for treatment. You like most Fibromyalgia patients need to experiment to find what works best for you with the least side effects. Good luck, a very frustrating disease to have and to treat.
Question: Hi. I really hope you can help. I took Prozac 20mg/day for nine years. After that time, I began to feel it was working less effectively (it was also causing muscle tension in my neck and upper back) and starting trying some different antidepressants. First was Selexa, which caused problems with sexual functioning and muscle tension but otherwise worked well. Then I was switched to Serzone. Sexual functioning returned but I had the strangest feeling all the time. Every time I turned my eyes rapidly to one side and or moved my head, I had a sensation of shock or surprise--like a little adrenaline jolt. It was awful. I was put on Effexor instead and 3-4 hours after taking the first Effexor the "shocky" feeling in my head disappeared. The Effexor, however, also caused profound sexual disfunction (complete loss of interest and inability to reach orgasm. So I tapered and discontinued the Effexor and after 2-3 days off it, the "shocky" feeling is back. Afte taking one Zoloft (my next option) the "shocky" feeling is almost gone. It now appears the "shocky" feeling is not related to the Serzone, but rather is a side effect of discontinuing an SRI type drug. What can be causing this? Must I take specifically an SRI for the rest of my life to avoid this weird feeling in my head? I took the Serzone for two weeks and had the weird feeling all the time so I know that it won't even begin to ease off within a two week period. And all the SRI's seem to cause sexual dysfunction. I feel extremely frustrated. I'd like to be off anti-depressants altogether but that seems to be an impossibility. Should I try Wellbutrin next? I am a recovering bulimic so I fear my doctor will be hesitant to prescribe Wellbutrin. Mainly, I want to know what can be causing the "shocky" feeling whenever I stop taking an SRI and what can be done about it. Thank you so very much for your advice.
Answer: Although the initial literature on the SRIs had no mention of this discontinuation syndrome about 5% of patients do experience some sort of problems on withdrawal. The symptoms vary quite a lot, but tend to last 4-6 weeks depending on the dosage and the patient. So far, I know of nothing that will speed up this process.
Question: I've been taking serzone for about 2-3 months could it still be making me sick at my stomach? I also have a decease in appetite is this one of the side effects?
And can I take allergy med's with serzone?
Answer: Usually it either increases or decreases ones appetite. About 20% of patients will experience continued weight loss. Nausea is less common, but probably your medication. You can check this by stopping it for a few days, if the nausea wanes then it's the medication, if not you need an evaluation.
Question: For the past two months I have been taking 50mg of Zoloft per day. At this stage, I have handled the usual side effects effectively save one. Since starting the drug I have been getting up through the night 3 to 5 times to urinate. At first I thought I was having a prostate problem but I now do not believe that to be the case. I have no trouble with flow or hesitation. I believe I may be suffering a side effect of Zoloft called nocturnia? The problem only exhibits itself at night. I have no problems at all during the day. Needless to say I am suffering from lack of sleep.
In addition to the urination problem, I am also having trouble getting and/or maintaining an erection. Attempting to have intercourse is a very frustrating event. A friend of mine who was also taking Zoloft for a short period of time complained about the sexual problem but did not have the nightly wake-up calls that I am experiencing. His doctor changed his medication from Zoloft to Serzone and he indicates that the sexual difficulty has disappeared.
1. At this stage is there a likelihood that my urination problem will subside or go away entirely?
2. Does Serzone have the nocturnia side effect?
3. Does Serzone effect sexual function in the same way as Zoloft?
Thank you very much.
Answer: The only way to test the urination problem is to stop the drug. However, I have not seen this problem with this drug. I would ensure that your have had your blood sugar checked recently. But if it goes away with stopping the drug-it's the drug. I have not seen nocturia with any of these drugs to any significant extent. Serzone and Celexa are thought to have less sexual effects than the other drugs like Prozac, Paxil etc.
Serzone and severe itching
Question: I have had a problem with severe itching for approx. 2 years. The area
has been the back of my scalp, recently, arm pits, creases in groin area, and frequent
"little itches" about my g ha. I have gotten some infections from the itching on
my scalp. It has interfered with my sleeping at night and also driving myself and friends
crazy. I've changed soaps, detergents, tried over the counter drugs, went to a
dermatologist, who put me on shampoos, antibiotics, and tried essential oil that reduce
itchy skin. My dermatologist felt that the serzone could be causing this. Have you heard
of itching as a side effect from this drug? I have been searching the web under this drug
name but, I have not come up with anything.
Answer: Haven't seen it, but it's an easily tested hypothesis. Just
stop it for 3-4 weeks and see the effect on the itching.
Could These Problems Be Serzone
Side Effects [posted 12/02/98]
Question: My mother is on Serzone and since taking it early last summer, she has
been experiencing upper leg pain which has not been "fixed" by her chiropractor.
Is this a side effect of serzone? It seems to be getting increasingly worse to the
point where she cannot walk very far at all without a "rest". She is only 47, so
I don't really think it is simply "old age". Thank you for any advice you can
Answer: Not the Serzone. Get an evaluation of her spinal cord and her
peripheral arterial flow.
Serzone [posted 10/2/98]
Question: I am currently taking serzone for my depression, I have read about
several drugs for depression that have side effects other than the one while on the
medication, for example, long term side effects that may not show up for 20 years. I am
very concerned about this, I know the side affects that is has now, and am dealing with
them, but if there is something that does not show up until later, I would like to know. I
have read about some drugs on the market that as been prescibed that they are just finding
out that there is serious side effects later in life. I would really appreciate any
information about this. Thank you for your time.
Answer: No current data on long term side effects. But, has been used in Europe
for about 15 years without any major problems reported. Used about 8-10 years here.
Serzone [posted 8/13/98]
Question: I have been placed on serzone by a pain management anesthesiologist. I
did not indicate to the physician in any way that I have any of the problems that it is
supposed to fix, but reading the pamphlet on the medication, if it does what it is
supposed to do for you. I have degenerative spine and disc disease, 5 major back surgeries
and severe neuropathy due to the nerve damage in my back. I am curious as to how this is
to help with pain management and is this used often to treat these symptoms? At the same
time, I was placed on neurontin 300 mg, 4 times per day. Is this medication used to treat
chronic pain often? What is the success rate? I understand it is an anti-epileptic
medication - will this medication have any adverse reactions to me, since I do not, and
have never had epileptic seizures?
Answer: There are many medications that are used to treat chronic pain. Like
many other medical problems what this really means is that nothing works very well.
However, some patients will really improve with different medications and they are worth a
trial to see their effectiveness versus the side effects. Many antidepressants and seizure
medications are on the list that physicians use to treat chronic pain. This is mainly due
to their ability to interact/change the chemical nature at the nerve/nerve or nerve/muscle
interface. I usually advocate trying them to see if they help. Granted you are being an
experiment, but there is no other way. In reality, every patient on every drug is an
experiment, yours is just more obvious than others.
Paxil to Serzone [posted 8/13/98]
Question: Should I stop taking Paxil for a specified length of time before starting
on Serzone? I have been taking 20 mg. of Paxil for eight week and have experienced severe
Answer: Most physicians recommend one to two weeks for a washout depending on
the severity of the depression.
Serzone [posted 8/5/98]
Question: What is the drug Serzone and what are the side effects? My wife is
currently on Paxil and has tried twice to wean herself unsuccessfully. I would appreciate
any help you can give us.
Answer: Serzone is a completely different drug than Paxil. It seems to be less
effective, but has much less effect on sleep and decreasing sex drive. Some patients have
less weight gain as well. Common side effects include dry mouth, nausea, constipation,
blurred vision, dizziness, confusion and sleepiness. Headache, decreased appetite,
diarrhea, etc., also occur, but less frequently. My patients generally tolerate it well if
started low and increased slowly. It does seem to affect sex drive less intensely than
Serzone and Dizziness
Question: I began taking serzone a couple of days ago and am experiencing extreme
dizziness as a side effect. I'm wondering if there's a medication that will relieve this
symptom. I say my dizziness is "extreme" because even if I'm just sitting in a
chair, I feel disoriented -- as if I'm about to fall. What bothers me most is the fact
that I can't go on my daily walks or occasional runs. Other than the dizziness and a
couple of other side effects, the serzone does seem to relieve my major depression. I have
tried almost every antidepressant medication out there, and most of them seem to work
great for a year to a year and a half, but then quit working. I've had the greatest
success with my most recent medication, Effexor. However, it recently lost its
effectiveness, so I made the switch to serzone.
Answer: There is probably no way to prevent this problem. Some patients will
develop tolerance over a few days, most will not. In order to tell if it is helping the
depression, you will need to be on it at least 3 weeks. You may see improvement in a week,
but quitting earlier is not going to give you an answer concerning its usefulness.
However, I doubt that you'll be able to tolerate this medication. I'd opt to stop it and
call your doctor to try a different antidepressant. Also, these medications don't lose
their effectiveness - you may need a higher dosage, but you don't develop resistance to
Question: My mother is taking Serzone. She has been told it is for a chemical
imbalance in her brain. She is losing her fine motor skills in her hands, and is having
difficulty walking. I understand that Serzone is an anti-depressant. Why is the Doctor
treating her with a antidepressant if she is having problems walking and doing simple
tasks like writing, washing dishes, and cooking. She is only 65 and has high blood
pressure, but until recently has been in good health. The Doctor seems to be connecting
what seems to be a physical problem, with depression. Is there a relationship between
depression, and the loss of motor skills?
Answer: Did the loss of fine motor skills precede the Serzone or did it come
after? If before, there is probably an underlying neurologic diagnosis which has not been
elucidated. If after, it is probably due to a side effect of the Serzone.
Question: What is it used for and any info that might help
Answer: Serzone(nefazodone hydrochloride) is an anti-depressant which is in a
class of its own in terms of structure. However,it appears to act like some other
serotonin uptake inhibitors It appears to be more selective in certain parts of the brain
and has less depressant effect on ones sex drive-a common problem with other SRls like
Prozac, Paxil, etc. It also may have less effect on sleep. I use it in my patients who are
having significant decrease of their sexual drive with SRls and have had moderate success
in improving depression while not affecting the patients sex drive. It is less convenient
to take-twice a day; but, the side effects don't appear to be significantly different
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