Nefazodone long-term effects

Geriatric Considerations - Summary Eszopiclone is the only hypnotic which has been shown to maintain efficacy over long-term use (6 months) and may have a role in the management of chronic sleep problems in olderadults. Because eszopiclone is a substrate of CYP C3A, and 2E1, it should be used with caution, especially with drugs such as nefazodone, clarithromycin, and amiodarone. This agent has been newly approved for use in the US and has not been well studied in terms of falls or other geriatric side effects. 

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Disadvantages of nefazodone include the need for a twice-a-day dosing schedule and dose adjustment. Work is under way to develop a once-a-day sustained release version of nefazodone. The fact that nefazodone must be started at a lower than usually effective dose and then adjusted to an effective dose is a distinct disadvantage. That is made even more problematic because arguably more variability exists among patients in terms of the optimal dose of nefazodone as far as efficacy and tolerability than for virtually any other antidepressant. Finally, nefazodone produces substantial inhibition of CYP 3A3/4, leading to the potential for adverse pharmacokinetic interactions as well as possible unknown long-term consequences. 

Masand PS, Gupta S. Long-term side effects of newer-generafion anfidepressanfs SSRIs, venlafaxine, nefazodone, bupropion, and mirtazapine. Ann Clin Psychiafry 2002 14(3) 175-82. 

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