Page 57 - Naplex Q&A 2025 Version

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for the treatment of depression. MAO inhibitors The recommended starting dose for Serzone
should be carefully prescribed with SSRIs, SSNRIs, (Nefazodone) is 200 mg/day, administered in two
tricyclic antidepressants and with tyramine divided doses (BID). Dose increases should occur in
containing products since the simultaneous use may increments of 100 mg/day to 200 mg/day, again on
cause severe hypertensive crisis. a BID schedule, at intervals of no less than 1 week.
Effective dose range is 300 mg to 600 mg per day.
95. (e) Marplan (Isocarboxazid) should be
discontinued at least 14 days before initiating the Serzone (Nefazodone) should be discontinued if
treatment with Prozac (Fluoxetine). Concurrent use clinical signs or symptoms suggest liver failure.
of Prozac with MAO inhibitors may result in Patients who develop evidence of hepatocellular
confusion, agitation, restlessness, G.I. symptoms, or injury such as increased serum AST or serum ALT
severe hypertensive crisis. levels ≥ 3 times the upper limit of normal, while on
Serzone (Nefazodone) should be withdrawn from
Because of the prolonged half-life of Prozac, it the drug. These patients should be presumed to be
should be discontinued at least 5 weeks before at increased risk for liver injury if Serzone
initiating therapy with any of MAO inhibitors. (Nefazodone) is reintroduced. Accordingly, such
patients should not be considered for re-treatment.
Meperidine, when concurrently used with MAO
inhibitors, may result in severe hypertensive crisis. Patients should be advised to be alert for signs and
Other drugs which need to be avoided with MAO symptoms of liver dysfunction (jaundice, anorexia,
inhibitors are Trazodone, caffeine, Methylphenidate gastrointestinal complaints, malaise, etc.) and to
Amphetamine, Dextroamphetamine and report them to their doctor immediately if they
Sympathomimetic amines. occur.

96.(d) The active component of Omnaris nasal spray It is available as hexagonal tablets containing 50 mg,
is Ciclesonide, a non-halogenated glucocorticoid. It 100 mg, 150 mg, 200 mg, or 250 mg of nefazodone
is indicated for the treatment of nasal symptoms hydrochloride
associated with seasonal allergic rhinitis in adults
and children 6 years of age and older. It is also 98.(e) Elixir contains 5 to 40% alcohol. All of the
indicated for the treatment of nasal symptoms mentioned drugs have been found to interact with
associated with perennial allergic rhinitis in adults alcohol and may produce disulfiram-like reactions.
and adolescents 12 years of age and older.
Ethanol is generally converted to acetaldehyde by
The recommended dose of Omnaris Nasal Spray is 2 an alcohol dehydrogenase enzyme, which is then
sprays per nostril (not by mouth) once daily (200 subsequently converted to acetic acid by action of
mcg). The maximum total daily dosage should not aldehyde dehydrogenase enzyme.
exceed 2 sprays in each nostril (200mcg/day).
Accumulation of acetaldehyde may be responsible
A pharmacist should question a physician about the for producing hot flashing, throbbing headaches
route of administration of the drug. and disulfiram-like reactions.

97.(a) The hepatic toxicity is principal side effect of All of the above drugs inhibit the aldehyde
Serzone (Nefazodone). dehydrogenase enzyme and produce disulfiram-like
reactions. Therefore, the final dosage form of these
Serzone (Nefazodone), a selective serotonin all mentioned drugs could not be an elixir.
norepinephrine reuptake inhibitor (SSNRI), is
indicated for the treatment of depression.

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