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Tips for tapering nefazodone (Serzone)


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Altostrata
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Due to reports of drug-induced liver damage and failure, nefazodone is very rarely prescribed. The US FDA has put an extensive black box warning about hepatotoxicity in the drug package.

 

(Only a few members here have tapered it, use search in the Introductions forum to find those discussions.)

 

Caution is warranted when using this drug along with other drugs(medications) or herbal preparations. Primarily metabolized via the liver CYP450 system. nefazodone is a potent inhibitor of liver enzyme CYP3A4, and may interact adversely with many commonly used medications also metabolized by CYP3A4. (See more at Nefazodone-Wikipedia.)

 

With its active metabolites, half-life of nefazodone is 11-24 hours; peak plasma level is attained 2-4 hours after a dose ( from 2014 FDA-approved label for nefazodone).

 

Currently produced by a very limited number of generic drug manufacturers and increasingly becoming unavailable (as of 08/11/2021), nefazodone tablets come in 50 mg; 100 mg; 150 mg; 200 mg; 250 mg sizes (from FDA-approved information about nefazodone). The tablets are not extended-release and may be split or crushed. 

 

We advise tapering by 10% per month, see Why taper by 10% of my dosage? The 10% is calculated on the last dose; the amount of reduction keeps getting smaller. If withdrawal symptoms appear at any time during this taper, they indicate you need to pause and let them settle down and probably go forward with smaller reductions. (A slight updose to the prior dosage level may be needed if withdrawal symptoms are significant.)

 

The options for tapering are tablet-splitting and using a scale to weigh and measure doses or using a liquid suspension.

 

Cutting up tablets
Being immediate-release, the tablets can be split.  

 

If you are taking 250mg per day, you might start your taper by getting your prescription filled with 200mg tablets and 50mg tablets. One way to reduce would be by cutting the 50mg tablet into quarters and reducing by 12.5mg (one-quarter of a 50mg tablet) per month until you are taking 200mg, then get your prescription filled with 150mg tablets and 50mg tablets and do the same until you are taking 125mg (3/4 of a 150mg tablet). The reductions will be within 10% of your monthly dosage.

 

At 125mg, you may want to use a scale to weigh tablet fragments or convert to a liquid formulation of nefazodone to maintain further reductions of 10% or less per month.

 

If you are combining tablet dosages to taper, your doctor may have to write the prescription for split doses (doses taken at different times of day) for insurance coverage.

 

 

Taper using a digital scale to measure doses

See Using a scale to weigh and measure doses

 

 

Have a compounding pharmacy make a liquid for tapering
With a prescription written for the custom drug, compounding pharmacies can make a liquid from the tablets or from possibly from specially ordered nefazodone powder. This can be very efficient and precise for tapering but quite expensive.

 

See Getting compound custom doses at compounding pharmacies

 

Taper by making your own liquid

Insoluble in water, nefazodone is soluble in DMSO (≥ 10 mg/ml) and ethanol (10 mM). Vodka, which contains ethanol, may be used to make a nefazodone solution. The amount of alcohol you'd take in a dose, would be very small, only a few milliliters.

 

One can also make a suspension of nefazodone powder in water or Ora-plus or Ora-sweet liquid, the suspension vehicles used by pharmacists. See 

How to make a liquid from tablets or capsules (first post defines how to suspend in water)

Pharmaceutical liquids to make suspensions

Using an oral syinge and other tapering techniques

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • Altostrata changed the title to Tips for tapering nefazodone (Serzone)
  • 2 weeks later...
DebbieM24

The problem is that Nefazodone is currently out of stock,, no powders,,, I am currently on 75mg & doing well with the help of CBD & supplements,,,

 

I will go to 50 when I run out of the 75s,,,  I pray I don’t have to go through 11 days of hell again,,,
 

the 100s I have I will break in half,, there is no way to do 10mg

1999 Began Serezone  21 yrs on & off others tried Lexspro, celexa & Wellbutrin after this, no good for me)

2019 100mg -occasional clonapin & ambien 

2020 150 mg to 200 mg 1x day occasional clonapin & ambien 

 

3/13/21 began taper crash from 200-100mg

3/17/21 150mg

4/1/ 21 125 mg

5/3 21 100 mg

6/27.  75mg occasional clonapin & ambien 

 

 

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DebbieM24

8/21 - 75mg + CBD

1999 Began Serezone  21 yrs on & off others tried Lexspro, celexa & Wellbutrin after this, no good for me)

2019 100mg -occasional clonapin & ambien 

2020 150 mg to 200 mg 1x day occasional clonapin & ambien 

 

3/13/21 began taper crash from 200-100mg

3/17/21 150mg

4/1/ 21 125 mg

5/3 21 100 mg

6/27.  75mg occasional clonapin & ambien 

 

 

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