Nefazodone

INTRODUCTION

Indications

Major depression. Unlabeled Use: Panic disorder, posttraumatic stress disorder (PTSD).

Action

Inhibits the reuptake of serotonin and norepinephrine by neurons. Antagonizes alpha₁-adrenergic receptors. Therapeutic Effects: Antidepressant action, which may develop only after several weeks.

Adverse Reactions/Side Effects

CNS: dizziness, insomnia, somnolence, agitation, confusion, weakness. EENT: abnormal vision, blurred vision, eye pain, tinnitus. Resp: dyspnea. CV: bradycardia, hypotension. GI: HEPATIC FAILURE, HEPATOTOXICITY, constipation, dry mouth, nausea, gastroenteritis. GU: erectile dysfunction. Derm: rashes. Hemat: decreased hematocrit.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hepatotoxicity and liver failure, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or other mental health care professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendixes G, H). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for agitation, confusion, or other alterations in mental status. Notify physician promptly if these symptoms develop (See Appendix D).

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall prevention strategies (See Appendix E).

• Because of the risk of bradycardia and other arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

• Help patient explore nonpharmacologic methods reduce depression and other psychologic disorders (exercise, counseling, support groups, and so forth).

Patient/Client-Related Instruction

• Advise patient that antidepressant effects may not occur immediately; it may take 2 wk or more before an improvement in mood is observed.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk ...