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Nefazodone and Neurotoxicity
Letter to the Editor
Sir: I would like to comment on the case report “Nefazodone and Symptoms Suggesting Neurotoxicity: A Case Report,” which raised the possibility of dose-related neurotoxicity with nefazodone and emphasized the need to pay close attention to all possible drug interactions.
While speculation was made on the possible interactions with carbamazepine and cyclobenzaprine, the authors failed to discuss possible interactions with risperidone even though the patient took carbamazepine, cyclobenzaprine, and risperidone in addition to nefazodone.
As was described in their letter, nefazodone is a potent inhibitor of cytochrome P450 3A4 isoenzyme and a weak inhibitor of cytochrome P450 2D6 isoenzyme, and it is highly protein bound.