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Serzone and Viibryd Starter Pack

Determining the interaction of Serzone and Viibryd Starter Pack and the possibility of their joint administration.

Check result:
Serzone <> Viibryd Starter Pack
Relevance: 27.09.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Talk to your doctor before using nefazodone together with vilazodone. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, blurred vision, muscle spasm or stiffness, tremor, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. In addition, nefazodone may increase the blood levels and effects of vilazodone. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Concomitant use of vilazodone with other agents that possess serotonergic activity including nefazodone may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

ADJUST DOSE: Coadministration with potent inhibitors of CYP450 3A4 including nefazodone may increase the plasma concentrations of vilazodone, which is primarily metabolized by the isoenzyme. According to the product labeling, concomitant use of vilazodone with potent CYP450 3A4 inhibitors can increase vilazodone plasma concentrations by approximately 50%.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

MANAGEMENT: The maintenance dosage of vilazodone should be reduced to 20 mg/day when used with potent CYP450 3A4 inhibitors.

References
  • Spina E, Scordo MG "Clinically significant drug interactions with antidepressants in the elderly." Drugs Aging 19 (2002): 299-320
  • McDaniel WW "Serotonin syndrome: early management with cyproheptadine." Ann Pharmacother 35(7-8) (2001): 870-3
  • Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  • Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2
  • Nijhawan PK, Katz G, Winter S "Psychiatric illness and the serotonin syndrome: an emerging adverse drug effect leading to intensive care unit admission." Crit Care Med 24 (1996): 1086-9
  • Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  • John L, Perreault MM, Tao T, Blew PG "Serotonin syndrome associated with nefazodone and paroxetine." Ann Emerg Med 29 (1997): 287-9
  • Mackay FJ, Dunn NR, Mann RD "Antidepressants and the serotonin syndrome in general practice." Br J Gen Pract 49 (1999): 871-4
  • Insel TR, Roy BF, Cohen RM, Murphy DL "Possible development of the serotonin syndrome in man." Am J Psychiatry 139 (1982): 954-5
  • Smith DL, Wenegrat BG "A case report of serotonin syndrome associated with combined nefazodone and fluoxetine." J Clin Psychiatry 61 (2000): 146
  • Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2
  • Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
  • Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  • "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC, New Haven, CT.
  • Lane R, Baldwin D "Selective serotonin reuptake inhibitor--induced serotonin syndrome: review." J Clin Psychopharmacol 17 (1997): 208-21
Serzone

Generic Name: nefazodone

Brand name: Serzone

Synonyms: n.a.

Viibryd Starter Pack

Generic Name: vilazodone

Brand name: Viibryd, Viibryd Starter

Synonyms: Viibryd

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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