Nefazodone: Liver Warning, Uses and Side Effects

What nefazodone is

Nefazodone is a prescription antidepressant tablet. MedlinePlus puts it in the class of serotonin modulators. It is sold as a generic: MedlinePlus notes that the older brand is no longer on the market, so we use only the generic name here.

Its label has a direct passage about liver safety, covered below. This page sums up that label and MedlinePlus. It is general information, not advice about your own treatment. You can see others on our list of medicines.

What it is approved for

The current FDA label says nefazodone is approved for the treatment of depression. That same section tells prescribers to consider the risk of liver failure when deciding among treatments, and says that in many cases this would lead to the conclusion that other medicines should be tried first. That wording is the label's own.

Safety and effectiveness have not been established in children and teens, and it is not approved for them. This page describes only the label's approved use.

How it is thought to work

The label says the mechanism of nefazodone is unknown. Lab studies show that it reduces the reuptake of serotonin and norepinephrine, and that it blocks a serotonin receptor called 5-HT2. It also blocks alpha1 receptors, which the label says may be linked to the drop in blood pressure some people have on standing.

What taking it can be like

The label says several weeks of treatment may be needed for the full effect. MedlinePlus says to keep all appointments with your doctor and the laboratory, since your doctor may order tests to check your response.

The label advises avoiding alcohol while taking nefazodone, and caution with driving or machinery until you know it does not affect your judgment, thinking or movement. Dizziness and lightheadedness are among its common effects, and the National Institute of Mental Health (NIMH) notes that medicines affect people in different ways.

Knowing the signs of liver trouble is part of day-to-day safety. Call your doctor immediately if you notice:

• Yellowing of the skin or eyes.
• Dark-colored urine.
• Nausea, vomiting or loss of appetite.
• Extreme tiredness or lack of energy.
• Unusual bleeding or bruising, pain in the upper right part of the stomach, or flu-like symptoms.

Boxed warnings and who should not take it

Liver failure: the label warns of life-threatening liver failure, including cases that led to transplant or death, and says there is at present no way to predict who is likely to develop it. Ordinarily, it says, treatment should not begin in people with active liver disease or raised liver enzymes. People whose blood tests show liver injury should come off it and should not be treated with it again.

Suicidal thoughts and behaviors: antidepressants increased this risk in children, teens and young adults in short-term studies. People of all ages taking an antidepressant should be watched closely for worsening, suicidal thoughts or unusual changes in behavior, and families should stay in touch with the prescriber.

If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. You can also see our crisis resources.

The label rules out use with terfenadine, astemizole, cisapride, pimozide or carbamazepine, in anyone previously taken off nefazodone because of liver injury, and in anyone allergic to it or to other phenylpiperazine antidepressants. It says triazolam should be avoided for most people taking nefazodone. It also recommends against use with an MAOI or within 14 days of stopping one, with at least 1 week allowed after nefazodone before an MAOI.

Side effects and other warnings

The most commonly observed side effects in the label are sleepiness, dry mouth, nausea, dizziness, constipation, weakness, lightheadedness, blurred or abnormal vision and confusion.

The label also describes a drop in blood pressure on standing, activation of mania or hypomania, seizures, and rare reports of priapism, a prolonged erection, which needs immediate medical attention. MedlinePlus adds that nefazodone may cause or worsen angle-closure glaucoma, and that rash, hives, or swelling with trouble breathing or swallowing need a call to your doctor immediately.

MedlinePlus says to keep taking nefazodone even if you feel well and not to stop it without talking to your doctor, who will probably want to lower the dose gradually. Tell your prescriber if you are pregnant, plan to become pregnant or are breastfeeding.

Can it be managed online in Pennsylvania and New York

The label does not require a clinic setting to take it. It also does not set a routine lab schedule, but it does say treatment ordinarily should not begin with raised liver enzymes, and it tells people to report signs of liver trouble right away. Any blood test has to be drawn in person. A video visit can cover the conversation: your symptoms, your history and your other medicines.

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO), treats depression by secure video for people physically located in Pennsylvania or New York during each visit. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help. See online depression treatment, psychiatry in New York or send us a medication question.

Our therapists do not prescribe. Their depression therapy is by video in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York, so New York readers can get psychiatry here but not therapy here. Depression can get better, and it is worth asking about every option open to you.