![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Tony C. on June 19, 2004, at 12:11:57
Hi, I am a 7 year SERZONE/NEFAZODONE user, my question is, if I am ABSOLUTELY FORCED to give up the Generic Serzone (Nefazodone) is TRAZODONE a good Alternative ? My Pharmacist said they are pretty similar. Any input from a Trazodone user, or someone knowledgeable will be greatly appreciated.
Sincerely - Tony C.
Posted by King Vultan on June 19, 2004, at 23:48:18
In reply to SERZONE/NEFAZODONE - COULD I SWITCH TO TRAZODONE ?, posted by Tony C. on June 19, 2004, at 12:11:57
> Hi, I am a 7 year SERZONE/NEFAZODONE user, my question is, if I am ABSOLUTELY FORCED to give up the Generic Serzone (Nefazodone) is TRAZODONE a good Alternative ? My Pharmacist said they are pretty similar. Any input from a Trazodone user, or someone knowledgeable will be greatly appreciated.
>
> Sincerely - Tony C.
>
Trazodone is easily the most similar drug to nefazodone, and if you look at the two molecules side by side, about 2/3 of the structure is identical. However, trazodone is quite a bit more sedating and is commonly used as a sleeping aid, whereas nefazodone is not. In the insomnia chapter in my book "Psychotropic Drugs" they have them listed like this for sedation:trazodone +++
nefazodone + to ++For comparison, Remeron, doxepin, and amitriptyline (three notoriously sedating drugs) are also listed as +++. Effexor is rated as + and nortriptyline is listed as ++. You could certainly try trazodone and see if you could tolerate the sedation, but if you can't, I suppose nortriptyline might also be worth trying. This is probably the next closest drug to nefazodone after trazodone, but unlike these other two drugs, nortriptyline is a significant blocker of amine reuptake, in this case, norepinephrine. However, it is not terribly dissimilar otherwise and is also quite inexpensive.
Todd
Posted by Pluto on June 20, 2004, at 0:13:28
In reply to Re: SERZONE/NEFAZODONE - COULD I SWITCH TO TRAZODONE ?, posted by King Vultan on June 19, 2004, at 23:48:18
Dear Tony,
If you are a male, I will never suggest trazodone for you, because trazodone may cause treatment resistant priapism and permanent impotence will be the result. This is highlighted in PDR. Although the incidence is rare, it still is a possibility. Think of other options available before you switch to trazodone. Nortriptyline is a fairtrade and is dirt cheap.
Best of luck, Never be a victim of a rare side efect.
PLS.
Posted by Tony C. on June 20, 2004, at 7:31:20
In reply to Re: SERZONE/NEFAZODONE - COULD I SWITCH TO TRAZODONE ? » King Vultan, posted by Pluto on June 20, 2004, at 0:13:28
Thanks for your replies, however I believe the throbbing hardon that won't go down is a side effect of Nefazodone also, is it even greater with Trazodone ? Or the same risk ? And as for the Nortryptaline, is that like similar to the mechanisms of Serzone/Nefazodone ? Cause I have really ONLY done well on Serzone/Nefazodone. Also I am in day #20 of reducing, I am down 20% of my regular dose, and so far so good, I have gone slow enough that the withdrawal has been very light and transient, and very comfortable. I am keeping my fingers crossed.
Thanks for your replies I need and appreciate them.
Tony C.
Posted by King Vultan on June 20, 2004, at 11:29:05
In reply to Re: SERZONE/NEFAZODONE - PRIAPISM ????, posted by Tony C. on June 20, 2004, at 7:31:20
> Thanks for your replies, however I believe the throbbing hardon that won't go down is a side effect of Nefazodone also, is it even greater with Trazodone ? Or the same risk ? And as for the Nortryptaline, is that like similar to the mechanisms of Serzone/Nefazodone ? Cause I have really ONLY done well on Serzone/Nefazodone. Also I am in day #20 of reducing, I am down 20% of my regular dose, and so far so good, I have gone slow enough that the withdrawal has been very light and transient, and very comfortable. I am keeping my fingers crossed.
>
> Thanks for your replies I need and appreciate them.
>
>
> Tony C.
I think people need to be aware of the risk of priapism for trazodone, but that be said, I just do not think it is worth worrying about. The truth is that other drugs with alpha-1 adrenergic blockades can also cause this (I noticed prolonged erections myself on nortriptyline, which is not really noted as a side effect of this drug). OTOH, I took trazodone as a sleep aid for a few nights earlier this year and noticed absolutely nothing of the kind.
Trazodone should be more likely to have effects in this area, however, because in addition to its alpha-1 blockade, it also has a fairly strong alpha-2 blockade, which is associated with sexual arousal (yohimbe, for example, selectively blockades alpha-2 adrenergic receptors). Add the two effects together in the same drug, and one would expect to have more of a risk of priapism. Even so, it winds up only being a rare side effect, with the number I've seen in the past being 1 out of 6-7000.
Only about half of nortriptyline's pharmacological profile is similar to that of nefazodone and trazodone. The three of these drugs all blockade serotonin 2A receptors and alpha 1 adrenergic receptors. They all are at least somewhat sedating, and none are terribly anticholinergic, with nortriptyline being the worst because it's a tricyclic that also blockades norepinephrine reuptake. I had a few months experience with nortriptyline and a few days with trazodone, and they struck me as being perhaps vaguely similar, but I do not react particularly well to sedating antidepressants.
Todd
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.