NEFAZODONE - ITS PLACE AMONG ANTIDEPRESSANTS

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, adv erse effects, and drug interactions of nefazodone, as well as to deter mine its place among currently available antidepressants. DATA SOURCES : A search of European and American literature using EMBASE and MEDLIN E was completed. Nefazodone was the search term. DATA SYNTHESIS: Nefaz odone is an antidepressant that blocks serotonin type 2 (5-HT2) recept ors in addition to inhibiting the reuptake of serotonin and norepineph rine. In double-blind, placebo-controlled studies, nefazodone demonstr ates antidepressant activity at dosages ranging from 400 to 600 mg/d. Sedation, dry mouth, nausea, and dizziness are the more common adverse effects of nefazodone. Nefazodone, an analog of trazodone, has not be en associated with priapism at this time, and may have fewer sexual ad verse effects than other antidepressants. More studies are needed to d etermine the potential role of nefazodone in treating anxiety, pain, a nd premenstrual syndrome. STUDY SELECTION: Only double-blind, placebo- controlled studies designed to establish the efficacy of nefazodone as an antidepressant were reviewed. CONCLUSIONS: Based on placebo-contro lled, double-blind, comparative trials, nefazodone demonstrates greate r efficacy than placebo, and equivalent efficacy to imipramine. Somnol ence, dry mouth, nausea, dizziness, and constipation are the most comm on adverse effects. Nefazodone appears to have a milder adverse effect profile than the tricyclic antidepressants, causes fewer sexual dysfu nctions than the serotonin selective reuptake inhibitors, and may caus e less dizziness than trazodone. Nefazodone at dosages of at least 300 mg/d provides another option for the treatment of depression.