Nefazodone Propranolol

Drugs that may affect HMG-CoA reductase inhibitors include alcohol, amiodarone, antacids, azole antifungals, bile acid sequestrants, cimetidine, cyclosporine, diltiazem, erythromycin, gemfibrozil, isradipine, nefazodone, niacin, nicotinic acid, omeprazole, phenytoin, propranolol, protease inhibitors, ranitidine, rifampin, St. John s wort, and verapamil. 

Drugs that affect nefazodone include general anesthetics, sibutramine, sumatriptan, buspirone, carbamazepine, and propranolol. Drugs that may be affected by nefazodone include alcohol, benzodiazepines, buspirone, carbamazepine, cisapride, digoxin, haloperidol, HMG-CoA reductase inhibitors, MAOIs, propranolol, St. John s wort, cyclosporine, and tacrolimus. 

Propranolol Decreased Cmax and AUC of propranolol increased Cmax/ Cmin/ and AUC of m-CCP metabolite of nefazodone... 

For treatment-resistant patients who do not respond to SSRIs or TCAs, or to the combination of TCAs/SSRIs with benzodiazepines, other antidepressants have shown at least some beneficial effects in alleviating PD symptoms (e.g. mirtazapine, moclobemide, nefazodone, phenelzine, reboxetine, and venlafaxine). Other agents have also been reported to exert beneficial effects in PD, especially when combined with SSRIs/TCAs (lithium, pindolol, and propranolol). In cases where all treatments have failed, valproate or olanzapine should be considered.2 - ° In order to optimize treatment, patients should avoid or reduce the consumption of compounds that could potentially induce/exacerbate panic attacks (e.g. caffeine, alcohol, and nicotine) and should exercise regularly. i... 

Nefazodone does not significantly affect the pharmacokinetics of propranolol. 

A study in 18 healthy subjects found that nefazodone 200 mg every 12 hours reduced the AUC of propranolol 40 mg every 12 hours by 14% and decreased the maximum plasma levels by 29%, but no clinically significant changes in the response to propranolol or relevant adverse responses were seen. The pharmacokinetics of the nefazodone were largely unchanged. No special precautions would therefore seem to be necessary if both drugs are used. 

Salazar DE, Marathe PH, Fulmor IE, Lee JS, Raymond RH, Uderman HD. Pharmacokinetic and pharmacodynamic evaluation during coadministration of nefazodone and propranolol in healthy men. J Clin Pharmacol (1995) 35, 1109-18. 

---