Nefazodone, a newer antidepressant is a phenylpiperazine derivative that inhibits the
reuptake of both norepinephrine and serotonin, and antagonizes 5-HT2A
and α1 adrenergic receptors. Compared with SSRIs nefazodone caused the
fewer activating symptoms, adverse gastrointestinal effects(nausea, diarrhea, anorexia)
and adverse effects of sexual function, but is associated with the more dizziness, dry
mouth, constipation, visual disturbances and confusion.
We report on 4 cases of visual disturbances and hallucinations in patients taking
nefazodone.
1) Nefazodone, as a 5-HT2A antagonist, might induce visual disturbances.
2) mCPP, metabolite of nefazodone might contribute to the hallucination through action
on 5-HT receptor.
3) Dopaminergic enhancing activity of nefazodone might cause hallucination.
The case report raises the possibility that dose-related perceptual disturbances may
exist with nefazodone. The fact emphasizes the need to pay close attention to all
possible drug interactions, particularly in patients treated with multiple psychoactive
agents, older patients, and patients with decreased hepatic function.
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