Nefazodone (Serzone) and Ketamine Therapy | Tovani Health
Serzone (Nefazodone) — Atypical antidepressant (5-HT2 antagonist + reuptake inhibitor; strong CYP3A4 inhibitor)
Verdict at Tovani Health
Compatible; the CYP3A4 inhibition can meaningfully raise ketamine levels.
Nefazodone and ketamine are compatible with awareness. The branded product (Serzone) was voluntarily withdrawn in 2003 due to rare hepatotoxicity, but generic nefazodone remains available. Two specifics for KAP planning: nefazodone is a strong CYP3A4 inhibitor and can substantially raise ketamine plasma levels, similar in magnitude to clarithromycin; and the rare hepatotoxicity history means baseline LFTs are reasonable.
If you take Serzone regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Serzone interacts with ketamine
Nefazodone antagonizes 5-HT2A receptors and inhibits serotonin reuptake, with the unique property of strong CYP3A4 inhibition that affects many co-prescribed drugs. Ketamine clearance via CYP3A4 slows substantially, raising exposure for a given dose.
What we do at intake
Disclose dose and how long you have been on it. Bring a recent LFT. We may adjust KAP dose downward to account for the CYP3A4 inhibition.
Bottom line
Nefazodone and ketamine are compatible with awareness. The branded product (Serzone) was voluntarily withdrawn in 2003 due to rare hepatotoxicity, but generic nefazodone remains available. Two specifics for KAP planning: nefazodone is a strong CYP3A4 inhibitor and can substantially raise ketamine plasma levels, similar in magnitude to clarithromycin; and the rare hepatotoxicity history means baseline LFTs are reasonable.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Serzone (Nefazodone) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthetic and Pain Therapy. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Clinical Pharmacokinetics. 2016. PMID: 27028535
Reviews CYP3A4 inhibitors affecting ketamine clearance.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 19, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.