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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Tony C. on August 8, 2004, at 12:53:55
Nov. 3, 2003 (Boston) - A new study suggests that psychiatrists should
be careful when prescribing nefazodone (Serzone), but they "don't have
to panic" about reports that the antidepressant can cause liver
damage.Athi P. Venkatesh, MD, reviewed medical records of 1,853 patients who
took the drug from Jan. 1, 1999, to Dec. 31, 2001, at Scott and White
Hospital in Temple, Texas. After reducing the sample to 359 patients
who had liver function tests (LFT) performed, he reported that 3.9%
(95% confidence interval, 2.1% - 6.5%) had an elevation attributable
to nefazodone."In our population, we did not find any patients with severe or even
very severe LFT elevation," he told Medscape in an interview here at
the American Psychiatric Association's 55th Institute on Psychiatric
Services. Dr. Venkatesh reported his results in a poster at the
meeting.The U.S. Food and Drug Administration put a "black box" warning on
nefazodone on Dec. 7, 2001, after reports of liver failure in three
patients. Since then, psychiatrists have debated whether to prescribe
nefazodone, which causes less sexual dysfunction than some alternative
drugs and is useful for insomnia.In addition to the case reports, Dr. Venkatesh said he has found only
one study documenting liver damage from nefazodone, which was
published in the May 2002 issue of the Canadian Journal of Psychiatry.
He questioned the results, however, because the data did not exclude
patients with contributing medical conditions such as cirrhosis or
other medications that can cause an elevated LFT.In their retrospective study, Dr. Venkatesh and coauthor Antunes
Phillip, MD, found 162 patients with elevated LFTs. They accounted for
45% of those tested for liver function, but included 90 patients who
had high LFTs before being prescribed nefazodone.Removing those patients from the sample left 72 patients who had their
first elevated LFTs after starting nefazodone: a prevalence of 20%
(95% confidence interval, 16% - 25%). Most patients (71%) had mild
elevations. The rise was moderate in 15%, severe in 11%, and very
severe in 2%.Further review revealed that 58 of these patients had a medical
condition or took a medication associated with elevated LFT. This left
only 14 patients for whom the change could be blamed on nefazodone.
All had mild elevation, except for one increase classified as
moderate.Dr. Venkatesh concluded that psychiatrists could prescribe nefazodone,
if they use caution. "You have to keep in the back of your mind that
this drug can cause a mild elevation in LFT. So you do a baseline LFT
before starting nefazodone and monitor it by doing one in six months,"
he said.APA 55th Institute on Psychiatric Services: Abstract 100. Presented
Oct. 31, 2003.Reviewed by Gary D. Vogin, MD
(TONY C.)
Posted by HappyGirl on August 8, 2004, at 13:34:01
In reply to SERZONE/NEFAZODONE IS NOT REALLY TO DANGEROUS READ, posted by Tony C. on August 8, 2004, at 12:53:55
Hi Tony C.:
Thanks for your 'update' regarding Serzone. Recently, having been NO responses to each of your past messages concerning 'Serzone', I've never missed your 'knowledgeable' posts on Serzone issues. Your concerns along with self-study on the 'Serzone' is totally admirable. No one else but you can do this much contribution on this regard.In my case,however ... (you may recall my name along with several responses to your posts in the past), I, TOO love this med., Serzone. However, I, somehow developed 'intense thirst' during sleep that interferes my daily activities extensively. For this, I started to suspect my 'mass dossage'(450 mg., t.i.d.) of the Serzone. Surely, after discontinuation of the Serzone, this annoying problem, 'intense thirst' completely eliminated from my system. However, I am UNABLE to quit the Serzone totally as my pdoc. advised me when he rxed 'Trazodone' for Serzone's replacement. On AD combo., 'Trazodone' 100 mg. before the bed., Serzone 150 mg. along with my breakfast in comjuction with Wellbutrin SR(generic form) 200 mg., I feel MUCH better with the time.
I have NO idea of why the Serzone made me SO thirsty during my sleep as knowing I had NO problem until this problem came to my attention.
If you have some knowledge in this regard, please offer me some 'insight,' since I'm still on Serzone, 150 mg.
Thanks for your 'terrific' posts based on your personal and 'endless' research on Serzone.
H.G.
Posted by Tony C. on August 8, 2004, at 14:45:06
In reply to Re: SERZONE/NEFAZODONE IS NOT REALLY TO DANGEROUS READ, posted by HappyGirl on August 8, 2004, at 13:34:01
Dear Happy girl, I have been on it 7 years 200mg a day. I have never had intense thirst, just INTENSE discomfort ---> Insomnia, Vivid Dreams, aches and pains, and mental flatness after a while of reducing, so I see the Doc in Sept. - I am aiming for 5mg reduction every 30 days, and off in 2 years or so, I would prefer to just have the peace of mind to know it will always be available for next 100 years, but I am not confident that will be so. It just makes me mad, that they scared so many Doctors and patients from trying this, it really has worked well, it is just a MONSTER to get off of. My BIGGEST fear, is that I will stay on it, and one of the Pressure Groups will be successful in getting it banned in Generic form, OR the Generic companies will say, "SORRY - POOR SALES, WE WILL STOP MAKING IT" Gosh that scares me, thinking I would have to get off in such a short time, I mean this is some NASTY stuff for me at least to reduce. We long term Serzone users got the raw deal, but I guess it is one of lifes many tests. Keep in touch Nikky, sorry I can't explain the intense thirst, you sure it might not be your other meds ?
Sincerely - Tony C. ; )
Posted by HappyGirl on August 8, 2004, at 23:52:20
In reply to Re: SERZONE/NEFAZODONE IS NOT REALLY TO DANGEROUS READ, posted by Tony C. on August 8, 2004, at 14:45:06
Hi Tony C.:
Thanks for your response. I really appreciate it. In regard to my 'intense thirst,' ... my pdoc. seemed to agree with my 'suspicion' on the mass dosage/450 mg. of Serzone/Nefadozone. He's a VERY nice pdoc., but with no explanation on this, ... just told me 'take a sister A.D., Trazodone 300 mg. before the bed. That dosage/300 mg. is an AWFULLY 'high dosage' for me, due to my 'easily' sedative nature on any pschyo. med. Then, I went on my way, ... from 75mg., 100 mg. and then 150 mg. depending on my 'instinct.' Trazodone is a kind 'slow' to work on the depressive side of my Bp, however I'm slowly getting to the point, feel almost normal. I may increase its dosage on weekly basis or prn, 'as needed basis.' It's a kind an older A.D., but surprisingly it works GOOD, ... at least for me. Another thing is very money-wise, more than a half the price of Nefadozone. Have you ever tried it?
For me, Serzone is a VERY first A.D. after several failure on other A.D.s, then I still have 'profound' gratitude, praise along with fond memory on this 'precious' A.D., Serzone.As for 'Serzone' future, ... unfortunately, my pdoc. did say something about this, ...but don't want to post here, then just leave it 'blank' surrounding it's future. I, too really hoping Serzone stays on the market for extended period, however we may need to think about other 'compatible' AD to the Serzone/Nefadozone, not right now, but in future. In the meantime, I'm still taking Serzone as long as it's available for us.
Another issue, ... 'intense thirst,' it's due to 'mass' or 'accumulation' of Serzone effect in my system. In your case, the 200 mg. for seven years is not regarded as 'mass,' then you have NO worry about this.Your 'up-date' on Serzone/Nefadozone is quite informative. Thanks for your time and effort on Serzone/Nefadone issue.
H.G.
Posted by Tony C. on August 9, 2004, at 7:48:45
In reply to Re: SERZONE/NEFAZODONE IS NOT REALLY TO DANGEROUS READ, posted by HappyGirl on August 8, 2004, at 23:52:20
I don't know what your P-Doc told you about the futurem but the FDA told me, that it is the sales and scare tactics used by lawyers etc. that make the sales so poor that the Generic companies may just yank it off. The FDA tolds me they go by science, and that the risk is VERY VERY remote, but that they can't force companies to manufacture it. I think we need to ask our Doctors, to ask whoever they have to, to PLEASE make sure that this stuff is ALWAYS available for those who have been on it years, like myself, you and others. So did your P-Doc tell you along the lines what the FDA told me ? I also had a very POPULAR P-Doc tell me he did not think they would ever get rid of the Generic because it helped so many, then he gave be an example of CYLERT for ADHD it caused liver failure, and had the heat put on, the Company of the Brand name pulled it, BUT the Generic has been alive and kicking for quite sometime. I mean we need our rights to take this stuff, we worked, SO HARD to get out of Depression and get fixed, why mess up something good ?
Sincerely - Tony C.
Posted by HappyGirl on August 9, 2004, at 9:10:54
In reply to Re: SERZONE/NEFAZODONE IS NOT REALLY TO DANGEROUS READ, posted by Tony C. on August 9, 2004, at 7:48:45
Hi Tony C.:
On my previous visit, about three weeks ago, my pdoc. 'recommended' Trazodone, because partly, in my guess, he 'believed' I have a 'good' tolerance to this med., as knowking that I've been taking a potent A.D., such as Zyprexa, WB sr and more. Besides this, I developed 'intense thirst' about which my pdoc. suspected on Nefadozone, mass dosage, 450 mg.Besides this, here where I live, there are 'a lot' of 'law-sue' against docotors, especially genecologisit/obsterician. I can NOT blame my pdoc. started his 'safety' net,... not rx any of those 'risky' psycho. med., because there is no evidence/proof for him NOT to get sued. When his patients got angry over his practice/rx, he/she might choose 'money' hungry tactics, ... get a hefty money out of the doctor.
However, I am a long-term(around 4 years) patient, then he may trust me on this matter. However, if he 'thinks' I'm able to switch more 'safer' and 'no risky' med., Trazodone, then his advice is VERY understandable.
My next visit is around early September. On my next visit, I will definitely talk about 'Serzone/Nefadozone' issue more adamantly. Because, like you, I can NOT afford to lose this med., Nefadozone at least until I get more stabilized. Trazodone is a good older A.D., however it seems a kind 'side-effect,' ... sedative/hang-over next day is not recommendable to some of folks. Thus, I've still on Nefadozone 150 mg., rather just on Trazodone 300 mg. which my pdoc. intially rxed.
Up to now, that's all I can say about Nefadozone issue. I, too, do my VERY best to keep Nefadozone on the market whether I take it or not in the future.
H.G.
This is the end of the thread.
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