Drug General Information (ID: DDISVEDFP6)
  Drug Name Buspirone Drug Info Nefazodone Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antianxiety Agents Antidepressants
  Structure

 Mechanism of Buspirone-Nefazodone Interaction (Severity Level: Major)
     Additive serotonergic effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Buspirone Nefazodone
      Mechanism Serotonergic effects
5-HT 1 receptor  Agonist
Serotonergic effects
Serotonin transporter  Inhibitor
      Key Mechanism Factor 1
Factor Name 5-HT 1 receptor Structure Sequence
Protein Family G-protein coupled receptor 1 family
Protein Function
G-protein coupled receptor for 5-hydroxytryptamine (serotonin). Also functions as a receptor for various drugs and psychoactive substances. Ligand binding causes a conformation change that triggers signaling via guanine nucleotide-binding proteins (G proteins) and modulates the activity of down-stream effectors, such as adenylate cyclase. Beta-arrestin family members inhibit signaling via G proteins and mediate activation of alternative signaling pathways. Signaling inhibits adenylate cyclase activity and activates a phosphatidylinositol-calcium second messenger system that regulates the release of Ca(2+) ions from intracellular stores. Plays a role in the regulation of 5-hydroxytryptamine release and in the regulation of dopamine and 5-hydroxytryptamine metabolism. Plays a role in the regulation of dopamine and 5-hydroxytryptamine levels in the brain, and thereby affects neural activity, mood and behavior. Plays a role in the response to anxiogenic stimuli.
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      Key Mechanism Factor 2
Factor Name Serotonin transporter
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Structure Sequence
METTPLNSQKQLSACEDGEDCQENGVLQKVVPTPGDKVESGQISNGYSAVPSPGAGDDTRHSIPATTTTLVAELHQGERETWGKKVDFLLSVIGYAVDLGNVWRFPYICYQNGGGAFLLPYTIMAIFGGIPLFYMELALGQYHRNGCISIWRKICPIFKGIGYAICIIAFYIASYYNTIMAWALYYLISSFTDQLPWTSCKNSWNTGNCTNYFSEDNITWTLHSTSPAEEFYTRHVLQIHRSKGLQDLGGISWQLALCIMLIFTVIYFSIWKGVKTSGKVVWVTATFPYIILSVLLVRGATLPGAWRGVLFYLKPNWQKLLETGVWIDAAAQIFFSLGPGFGVLLAFASYNKFNNNCYQDALVTSVVNCMTSFVSGFVIFTVLGYMAEMRNEDVSEVAKDAGPSLLFITYAEAIANMPASTFFAIIFFLMLITLGLDSTFAGLEGVITAVLDEFPHVWAKRRERFVLAVVITCFFGSLVTLTFGGAYVVKLLEEYATGPAVLTVALIEAVAVSWFYGITQFCRDVKEMLGFSPGWFWRICWVAISPLFLLFIICSFLMSPPQLRLFQYNYPYWSIILGYCIGTSSFICIPTYIAYRLIITPGTFKERIIKSITPETPTEIPCGDIRLNAV
Gene Name SLC6A4
Uniprot ID SC6A4_HUMAN
KEGG Pathway hsa:6532
Protein Family Sodium:neurotransmitter symporter (SNF) (TC 2.A.22) family
Protein Function
Serotonin transporter whose primary function in the central nervous system involves the regulation of serotonergic signaling via transport of serotonin molecules from the synaptic cleft back into the pre-synaptic terminal for re-utilization. Plays a key role in mediating regulation of the availability of serotonin to other receptors of serotonergic systems. Terminates the action of serotonin and recycles it in a sodium-dependent manner.
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      Mechanism Description
  • Additive serotonergic effects by the combination of Buspirone and Nefazodone 

Recommended Action
      Management A lower initial dosage of buspirone (e.g., 2.5 mg/day) is recommended when used in combination with nefazodone. Patients should be closely monitored for the development of serotonin syndrome, which may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, and ataxia and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. The onset of symptoms is usually rapid--often within a day but sometimes longer--following initiation or addition of a drug, a dosage change, or overdose.

References
1 Goldberg RJ, Huk M "Serotonin syndrome from trazodone and buspirone." Psychosomatics 33 (1992): 235-6. [PMID: 1557493]
2 John L, Perreault MM, Tao T, Blew PG "Serotonin syndrome associated with nefazodone and paroxetine." Ann Emerg Med 29 (1997): 287-9. [PMID: 9018197]
3 Margolese HC, Chouinard G "Serotonin syndrome from addition of low-dose trazodone to nefazodone." Am J Psychiatry 157 (2000): 1022. [PMID: 10831493]