Nefazodone (Dutonin)

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This information is for people who are currently taking nefazodone (Dutonin) and will need to withdraw from this drug, and possibly start taking a replacement
anti-depressant.

Discontinuation of nefazodone
This antidepressant is being discontinued by its manufacturers. Starter packs are being stopped immediately. Other packs will no longer be available after 31 May 2003. This is a commercial decision due to declining sales; it is not a safety issue nor due to adverse effects.

If you are taking nefazodone, you will need to withdraw and possibly to start taking an alternative antidepressant.

How to withdraw
You are advised to withdraw slowly from all antidepressants, by reducing the dose over a period of at least four weeks. Stopping suddenly may cause withdrawal symptoms. If you do get withdrawal symptoms, you should slow the rate of withdrawal. If you get them after you have stopped, then they should pass within about two weeks.

In some cases it is preferable to start on a gradually increasing dose of a replacement antidepressant whilst reducing the dose of nefazodone.

If you are starting on another antidepressant at the same time as withdrawing from nefazodone, there are two possible problems:

• interaction between the two drugs
• symptoms of withdrawal from nefazodone may be confused with side effects of the replacement drug.

The Maudsley Prescribing Guidelines give the following advice on switching from nefazodone to other antidepressants:

Antidepressant advice

Citalopram (Cipramil) Withdraw, then start citalopram.

Fluoxetine (Prozac) Withdraw, then start fluoxetine.

Paroxetine (Seroxat) Withdraw, then start paroxetine.

Sertraline (Lustral) Withdraw, then start sertraline.

Reboxetine (Edronax) Withdraw, start reboxetine at 2 mg twice daily, and increase cautiously.

Venlafaxine (Efexor) Withdraw, start venlafaxine at 37.5 mg per day.

Mirtazapine (Zispin) Withdraw, start mirtazapine cautiously.

Tricyclics Cross-taper cautiously with very low dose of tricyclic.

MAOIs/hydrazines Withdraw and wait at least one week.

Tranylcypromine (Parnate) Withdraw and wait at least one week.

Moclobemide (Manerix) Withdraw and wait at least one week.

Source: Information from Bristol Myers Squibb (manufacturers of nefazodone).

Summaries of product characteristics and patient information leaflets for all antidepressants can be found on the Electronic Medicines Compendium at www.emc.vhn.net

Mind Information Unit, March 2003.