Nefazodone

SERZONE

Open Nefazodone in the interactive console ↗

Pronunciation: nef-AY-zoe-doen

Nefazodone ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Nefazodone ballicule

Nefazodone SERZONE mascot mnemonic cartoon — Visual mnemonic: Nefazodone mascot
**“Neph’s Sear zone / Nefarious Sear zone”**
Strong CYP3A4 inHibitor
Boxed warning: acute liver failure

What it isSerotonin 5-HT2 antagonist and reuptake inhibitor; depression.

Why this oneIt causes little sexual dysfunction and does not suppress REM sleep, unlike most antidepressants.

What limits itRare but fatal hepatic failure ended its widespread use. A strong CYP3A4 inhibitor.

Nefazodone molecular structure (skeletal formula) — Molecular structure: Nefazodone

FDA-approved for

depression (1994)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Suicidality — increased risk of suicidal thinking/behavior in children, adolescents, and young adults; not approved for pediatric use

FDA dosing	Population	Start	Target	Max
Depression	Adults	200 mg/day BID	300–600 mg/day BID	600 mg/day
Depression	Elderly/debilitated	100 mg/day BID	titrate to response	600 mg/day

Titration Increase in increments of 100–200 mg/day at intervals of no less than 1 week

Renal Undefined

Hepatic Undefined (contraindicated if prior nefazodone-associated liver injury)

Instructions

Allow ≥14 days after stopping an MAOI before starting nefazodone
Allow ≥7 days after stopping nefazodone before starting an MAOI

Available strengths

tab 50, 100, 150, 200, 250 mg

Contraindications

Prior withdrawal from nefazodone due to evidence of liver injury
Coadministration with carbamazepine, pimozide, cisapride, terfenadine, or astemizole

Cautions

MAOIs due to risk of serotonin syndrome
Hepatotoxicity / hepatic failure (can be fatal)
Suicidality
Postural hypotension
Visual disturbances (blurred/abnormal vision, scotomata)

Adverse reactions

Somnolence
Dry mouth
Nausea
Dizziness
Constipation
Asthenia
Lightheadedness
Blurred vision
Confusion
Headache

Pregnancy Category C; use only if potential benefit justifies risk to fetus

Lactation Undefined

Cost

Nefazodone (SERZONE)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
50 mg	tab	60 BID		offered
100 mg	tab	60 BID	$69.94	offered
150 mg	tab	60 BID	$75.75	offered
200 mg	tab	60 BID	$79.84	offered
250 mg	tab	60 BID		offered

Generic entry2003

⚠ BOXED WARNINGS

Life-threatening hepatic failure
Suicidal thoughts and behaviors in patients under 25

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityRare but potentially fatal hepatic failure and clinically important CYP3A inhibition.

Serotonicity

This drug is routinely called serotonergic. By Gillman’s human-effect criteria it does not raise serotonin in the synapse.

Not a clinically significant SRI; receptor antagonism is not serotonin elevation.

It binds the serotonin transporter, and its SERT peg is drawn to that textbook affinity. The pale halo around the peg marks binding that, by Gillman’s human-effect criteria, does not produce clinical serotonin reuptake inhibition.

Gillman’s four human testsA measurable SERT affinity that fails all four is not clinical serotonicity.