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.

Serzone and severe itching [posted 1/12/99]
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 body. 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 offer.

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 sexual dysfunction.

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 Paxil.

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 their mechanisms.

Serzone
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.

General Info
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 clinically.



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