Drug Interaction Report

MONITOR: Nefazodone may potentiate the hypotensive effect of many drugs including vasodilators and antihypertensive agents. Orthostatic hypotension may occur. In clinical studies, nefazodone was associated with potentially significant blood pressure decreases (SBP 90 mmHg or less and at least 20 mmHg decrease from baseline) in 5.1% of patients, postural hypotension in 2.8%, and syncope in 0.2% (versus 0.3% for placebo).

MANAGEMENT: Caution and close monitoring for altered efficacy and safety are recommended if patients receive nefazodone with agents that can produce significant hypotension such as antihypertensive agents or vasodilators. Patients should be made aware of the possible side effects (e.g., dizziness, lightheadedness, orthostasis) and be cautioned about driving, operating machinery, or performing other hazardous tasks. They should also be advised to avoid rising abruptly from a sitting or recumbent position and to contact their physician if they experience symptoms of hypotension such as dizziness, lightheadedness, or fainting.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.