Drug interactions
Nefazodone + Propafenone
Severity: Major
Nefazodone and Propafenone: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Nefazodone is a potent CYP3A4 inhibitor, and propafenone is metabolized partly by CYP3A4 and CYP1A2 in addition to CYP2D6. Raised propafenone concentrations can cause conduction abnormalities, proarrhythmia and bradycardia, especially in CYP2D6 poor metabolizers or those taking CYP2D6 inhibitors.
What this interaction means in plain words
Nefazodone and Propafenone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Nefazodone inhibits CYP3A4-mediated metabolism of propafenone, increasing its plasma concentration.
What to do
Avoid the combination if possible; otherwise monitor ECG (PR, QRS) and heart rate and reduce the propafenone dose as needed.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Propafenone
- Dofetilide + Propafenone Contraindicated
- Dronedarone + Propafenone Contraindicated
- Nilotinib + Propafenone Contraindicated
- Nirmatrelvir / ritonavir + Propafenone Contraindicated
- Nirmatrelvir + Propafenone Contraindicated
- Pimozide + Propafenone Contraindicated
Frequently asked questions
Can I take Nefazodone with Propafenone?
MediHelp rates the interaction as major. Nefazodone and Propafenone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Nefazodone is a potent CYP3A4 inhibitor, and propafenone is metabolized partly by CYP3A4 and CYP1A2 in addition to CYP2D6. Raised propafenone concentrations can cause conduction abnormalities, proarrhythmia and bradycardia, especially in CYP2D6 poor metabolizers or those taking CYP2D6 inhibitors.
How serious is the interaction between Nefazodone and Propafenone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible; otherwise monitor ECG (PR, QRS) and heart rate and reduce the propafenone dose as needed.
What other medicines interact with Propafenone?
MediHelp also lists interactions of Propafenone with, for example, Dofetilide, Dronedarone, Nilotinib. The full list is on the Propafenone page.
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