Products
Reboxetine is commercially available in tablet form (Edronax). It has been approved in some European countries since 1997 and in many countries since 2000.
Structure and properties
Reboxetine (C19H23NO3, Mr = 313.4 g/mol) is a morpholine derivative with two chiral centers. It exists in the drug as a mixture of the ,- and ,-enantiomers.
Effects
Reboxetine (ATC N06AX18) has antidepressant properties. It is a selective and potent reuptake inhibitor of norepinephrine and increases the concentration of the neurotransmitter in the synaptic cleft. The effects are based on inhibition of the neurotransmitter transporter NET. In the scientific literature, the antidepressant is controversial. According to a study by the Institute for Quality and Efficiency in Health Care and a review paper from 2010 (Eyding et al., 2010), reboxetine is clinically ineffective and possibly harmful to health. That it was nevertheless approved is attributed to selective publication (publication bias): Only studies with positive results were published; negative ones were withheld by the company. In many countries, the indication was restricted to “major depressive episodes” in 2013.
Indications
For the treatment of major depressive episodes.
Dosage
According to the SmPC. The drug is administered twice daily, regardless of meals. It should be prescribed only by doctors experienced in depression treatment.
Contraindications
- Hypersensitivity
- Concurrent administration of MAO inhibitors.
For complete precautions, see the drug label.
Interactions
Reboxetine is biotransformed and inactivated by CYP3A4 and is a weak inhibitor of this isoenzyme. Concomitant use of other antidepressants has not been studied. Hypokalemia is possible with concomitant use of diuretics.
Adverse effects
The most common possible adverse effects include insomnia, drowsiness, headache, dry mouth, nausea, sweating, voiding difficulty, and urinary retention in men. Dizziness, hypotension, accommodation disorders, and loss of appetite are also common.
