Psycho-Babble Medication Thread 1111872

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Re: Urgent--substitute for nefazodone (unavailable) » linkadge

Posted by Noa on August 26, 2020, at 11:20:33

In reply to Re: Urgent--substitute for nefazodone (unavailable), posted by linkadge on August 26, 2020, at 11:04:18

Thank you.

I read a little online about trazodone and nefazodone and it also seemed to me that it's closely related enough that maybe it could at least ward off the withdrawal symptoms, even if it doesn't produce the same level of antidepressant effect for me. I think it's the 5-HT2A antagonism that I need.


> Trazodone would probably be the closest drug. It too can help with sleep. I wouldn't be sure on the exact dosage conversion, but you could start with 50-100mg and work your way up.
>
> Linkadge

 

Re: Urgent--substitute for nefazodone (unavailable)

Posted by linkadge on August 26, 2020, at 14:05:28

In reply to Re: Urgent--substitute for nefazodone (unavailable) » linkadge, posted by Noa on August 26, 2020, at 11:20:33

Yeah, they are very similar. I think too they produce similar metabolites. They both have some degree of 5-ht1a agonism and 5-ht2 antagonism. Trazodone might be a bit more sedating. I think one difference is that nefazodone acts as on norepinephrine reuptake (to some extent) as well as serotonin reuptake. You may not noticed this, as effexor has actions there as well.

Both nefazodone and trazodone are relatively weak reuptake inhibitors (as compared to actions at specific monoamine receptors).

Linkadge

 

Re: Urgent--substitute for nefazodone (unavailable) » linkadge

Posted by Noa on August 26, 2020, at 14:17:32

In reply to Re: Urgent--substitute for nefazodone (unavailable), posted by linkadge on August 26, 2020, at 14:05:28

Thanks again for the info, Linkadge.

I finally found a pharmacy that has the nefazodone in stock--yay! It's a bit out of the way, but worth the trip not to suffer withdrawal!

But good to know about the trazodone in case this comes up again, which it might. Med supply issues do show up every now and then.

Thanks.

 

Re: Urgent--substitute for nefazodone (unavailable) » Noa

Posted by porkpiehat on September 3, 2020, at 20:27:59

In reply to Re: Urgent--substitute for nefazodone (unavailable) » linkadge, posted by Noa on August 26, 2020, at 14:17:32

> Thanks again for the info, Linkadge.
>
> I finally found a pharmacy that has the nefazodone in stock--yay! It's a bit out of the way, but worth the trip not to suffer withdrawal!
>
> But good to know about the trazodone in case this comes up again, which it might. Med supply issues do show up every now and then.
>
> Thanks.


Glad this worked out for you! I was going to put my two cents in for trazodone. Maybe get some just in case there is another shortage. Serzone has really fallen out of favor.

BTW...does the serzone help you with sexual side effects of the effexor?

 

Re: Urgent--substitute for nefazodone (unavailable) » porkpiehat

Posted by Noa on September 7, 2020, at 8:05:30

In reply to Re: Urgent--substitute for nefazodone (unavailable) » Noa, posted by porkpiehat on September 3, 2020, at 20:27:59

> BTW...does the serzone help you with sexual side effects of the effexor?
>
No

 

Re: substitute for nefazodone (unavailable) update

Posted by Noa on September 25, 2020, at 19:58:59

In reply to Re: Urgent--substitute for nefazodone (unavailable) » porkpiehat, posted by Noa on September 7, 2020, at 8:05:30

So my psychopharm did prescribe Trazodone as well as Nefazodone in case the Nefazodone is unavailable again.

And it is (unavailable again).

So tonight is my first dose of Trazodone. 50 mg. I was taking 500 mg of Nefazodone every night.

My main goal is to not have Nefazodone withdrawal symptoms but it would also be nice if the Trazodone produced some antidepressant effect itself or boosts the antidepressant effect of the Effexor, which the Nefazodone did.

I should have asked y'all about dosage before. Will the 50 mg of Trazodone be sufficient for me?

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 4, 2020, at 2:17:33

In reply to Re: substitute for nefazodone (unavailable) update, posted by Noa on September 25, 2020, at 19:58:59

I take 75mg Trazodone and I get some antidepressant effect from it. I don't want to recommend a dosage here because I don't want to be responsible for you being unwell. 50mg is low though.

> So my psychopharm did prescribe Trazodone as well as Nefazodone in case the Nefazodone is unavailable again.
>
> And it is (unavailable again).
>
> So tonight is my first dose of Trazodone. 50 mg. I was taking 500 mg of Nefazodone every night.
>
> My main goal is to not have Nefazodone withdrawal symptoms but it would also be nice if the Trazodone produced some antidepressant effect itself or boosts the antidepressant effect of the Effexor, which the Nefazodone did.
>
> I should have asked y'all about dosage before. Will the 50 mg of Trazodone be sufficient for me?
>

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Noa on December 4, 2020, at 3:35:22

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 4, 2020, at 2:17:33

Thank you. Youre rightit is low. So far, Im doing ok on it. The doctor is open to raising it if needed. At this point, Im ok holding at 50 for a while.

> I take 75mg Trazodone and I get some antidepressant effect from it. I don't want to recommend a dosage here because I don't want to be responsible for you being unwell. 50mg is low though.

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 6, 2020, at 5:40:11

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Noa on December 4, 2020, at 3:35:22

It is not to say that it won't work. It does for me. It worked better in the first 4 months and now plateaued a bit. It is one tool in the arsenal. There is an evil metabolite that may cause trouble with higher dosages. I tried 100, I didn't feel well.


> Thank you. Youre rightit is low. So far, Im doing ok on it. The doctor is open to raising it if needed. At this point, Im ok holding at 50 for a while.
>
> > I take 75mg Trazodone and I get some antidepressant effect from it. I don't want to recommend a dosage here because I don't want to be responsible for you being unwell. 50mg is low though.
>

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Noa on December 6, 2020, at 8:21:30

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 6, 2020, at 5:40:11

Thank you for all your insights!

> It is not to say that it won't work. It does for me. It worked better in the first 4 months and now plateaued a bit. It is one tool in the arsenal. There is an evil metabolite that may cause trouble with higher dosages. I tried 100, I didn't feel well.


 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 6, 2020, at 8:49:50

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Noa on December 6, 2020, at 8:21:30

Dont mention it. We hear the word unavailable a lot these days. The result is often a disaster. You are lucky

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Noa on December 6, 2020, at 10:34:03

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 6, 2020, at 8:49:50

I know. I was afraid it would be a disaster for me, so I do feel lucky!

> Dont mention it. We hear the word unavailable a lot these days. The result is often a disaster. You are lucky

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 6, 2020, at 13:59:07

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Noa on December 6, 2020, at 10:34:03

Is the liver issue any problem? Nefazodone sounds very interesting. But the Hospital told me they don't use it anymore because somebody died. Whats up with that?

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Noa on December 6, 2020, at 16:13:41

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 6, 2020, at 13:59:07

Yes, years ago, there were reports of a death or several, not sure, due to liver damage. So nefazodone got a black box warning and many doctors stopped prescribing it. Then the manufacturer of the brand name, Serzone, stopped making it. For a while, those of us who were taking it were concerned the generic would also stop being made. But it wasnt. As for the risk, my doctor said that if I were to have a severe liver reaction, it would have happened early in the treatment. Nevertheless, I get my liver enzymes checked regularly, as one should do anyway when on several serious medications. Also, the doctor said that the deaths did not represent a significant number of any kind. Just that adverse events have to be reported. Not that any death is acceptable, of course.


> Is the liver issue any problem? Nefazodone sounds very interesting. But the Hospital told me they don't use it anymore because somebody died. Whats up with that?
>
>

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 7, 2020, at 3:35:31

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Noa on December 6, 2020, at 16:13:41

Yeah, it is a pretty hardcore side effect I would say, no matter how infrequent. I have heard really good things about it other than that though.

 

Re: Urgent--substitute for nefazodone (unavailable)

Posted by Skeletor on December 18, 2020, at 16:44:33

In reply to Urgent--substitute for nefazodone (unavailable), posted by Noa on August 26, 2020, at 9:37:19

A good substitute for Nefazodone would probably be Nortriptyline at low dosage (e.g. 25mg). It exhibits 5HT2 antagonist properties, is good for sleep via moderate H1-antagonism, and acts as a rather strong NRI and weak SRI... At low dosages it should feel somewhat related to Nefazodone, although you have to count in anticholinergic side effects.

Another similar alternative would be Amoxapine: https://en.wikipedia.org/wiki/Amoxapine

ohh, and yes.... Aripiprazole's pharmacology isn't that dissimilar: https://en.wikipedia.org/wiki/Aripiprazole

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Skeletor on December 18, 2020, at 16:46:11

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 6, 2020, at 13:59:07

> Is the liver issue any problem? Nefazodone sounds very interesting. But the Hospital told me they don't use it anymore because somebody died. Whats up with that?
>
>

Apparently on in every 300,000 treated people got some liver problems....

 

Re: substitute for nefazodone (unavailable) update » Noa

Posted by Skeletor on December 18, 2020, at 16:48:00

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Noa on December 6, 2020, at 16:13:41

It's a shame. It is a good drug and it isn't even entirely clear if the liver problems stem from taking Nefazodone.

> Yes, years ago, there were reports of a death or several, not sure, due to liver damage. So nefazodone got a black box warning and many doctors stopped prescribing it. Then the manufacturer of the brand name, Serzone, stopped making it. For a while, those of us who were taking it were concerned the generic would also stop being made. But it wasnt. As for the risk, my doctor said that if I were to have a severe liver reaction, it would have happened early in the treatment. Nevertheless, I get my liver enzymes checked regularly, as one should do anyway when on several serious medications. Also, the doctor said that the deaths did not represent a significant number of any kind. Just that adverse events have to be reported. Not that any death is acceptable, of course.
>
>
> > Is the liver issue any problem? Nefazodone sounds very interesting. But the Hospital told me they don't use it anymore because somebody died. Whats up with that?
> >
> >
>
>

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 19, 2020, at 18:37:44

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Skeletor on December 18, 2020, at 16:46:11

I am not so sure that is what "patient years" means.

> Apparently on in every 300,000 treated people got some liver problems....

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Skeletor on December 19, 2020, at 18:46:30

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 19, 2020, at 18:37:44

Yes, but there were stats according to which every Nefazodone-patient takes the drug for approx a year (average). One could therefore...

> I am not so sure that is what "patient years" means.
>
> > Apparently on in every 300,000 treated people got some liver problems....
>
>

 

Re: Urgent--substitute for nefazodone (unavailable) » Skeletor

Posted by Noa on December 20, 2020, at 12:19:59

In reply to Re: Urgent--substitute for nefazodone (unavailable), posted by Skeletor on December 18, 2020, at 16:44:33

I thought I posted a reply but dont see it now, so Ill try again.
Thank you, Skeletor for that information. I have never tried Nortrtiptyline or Amoxapine. I was on Aripriprazole for about 5 years, though. I think it helped with get up and goie, countering the inertia of depression. But I went off of it earlier this year when my blood glucose was persistently rising. I thought going off of it might help enough to prevent needing a second diabetes medication. But it didnt, so I had to start the additional diabetes medication in July.
Meanwhile, I feel Im doing pretty well with what I guess is a low dose (50 mg) of Trazodone in place of the Nefazodone. Very relieved about that because I was so anxious about going off the Nefazodone after so many years.

> A good substitute for Nefazodone would probably be Nortriptyline at low dosage (e.g. 25mg). It exhibits 5HT2 antagonist properties, is good for sleep via moderate H1-antagonism, and acts as a rather strong NRI and weak SRI... At low dosages it should feel somewhat related to Nefazodone, although you have to count in anticholinergic side effects.
>
> Another similar alternative would be Amoxapine: https://en.wikipedia.org/wiki/Amoxapine
>
> ohh, and yes.... Aripiprazole's pharmacology isn't that dissimilar: https://en.wikipedia.org/wiki/Aripiprazole

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 21, 2020, at 8:26:15

In reply to Re: substitute for nefazodone (unavailable) update » Lamdage22, posted by Skeletor on December 19, 2020, at 18:46:30

Oh ok, that is not much. Would mean that it is safer than driving. Hmm. Makes me think. The reviews are encouraging. Does it cause people to be much less alert? Can they still drive?

> Yes, but there were stats according to which every Nefazodone-patient takes the drug for approx a year (average). One could therefore...

 

Re: substitute for nefazodone (unavailable) update

Posted by Lamdage22 on December 21, 2020, at 8:28:42

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 21, 2020, at 8:26:15

If i don't come across anything too discouraging, I am going to ask my doctor. Thanks for sharing!

> Oh ok, that is not much. Would mean that it is safer than driving. Hmm. Makes me think. The reviews are encouraging. Does it cause people to be much less alert? Can they still drive?
>
> > Yes, but there were stats according to which every Nefazodone-patient takes the drug for approx a year (average). One could therefore...
>

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Noa on December 21, 2020, at 13:24:37

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 21, 2020, at 8:26:15

I assume youre talking about Nefazodone? FWIW, my experience is: I always took it at night and had no problems driving the next day. However, since it did make me drowsy, I wouldnt want to drive within a few hours of taking it.


> Oh ok, that is not much. Would mean that it is safer than driving. Hmm. Makes me think. The reviews are encouraging. Does it cause people to be much less alert? Can they still drive?
>
> > Yes, but there were stats according to which every Nefazodone-patient takes the drug for approx a year (average). One could therefore...
>

 

Re: substitute for nefazodone (unavailable) update » Lamdage22

Posted by Skeletor on December 24, 2020, at 17:40:41

In reply to Re: substitute for nefazodone (unavailable) update, posted by Lamdage22 on December 21, 2020, at 8:26:15

From what I have read its antihistamine effects can be somewhat sedating at the beginning, but you can take it at night and after a few weeks you get used to it.

> Oh ok, that is not much. Would mean that it is safer than driving. Hmm. Makes me think. The reviews are encouraging. Does it cause people to be much less alert? Can they still drive?
>
> > Yes, but there were stats according to which every Nefazodone-patient takes the drug for approx a year (average). One could therefore...
>


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