Drug Action
Reboxetine is a selective inhibitor of noradrenaline re-uptake. Selectively inhibit the re-uptake of serotonin (5-hydroxytryptamine, 5-HT).
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Drug reference
Reboxetine is a selective inhibitor of noradrenaline re-uptake. Selectively inhibit the re-uptake of serotonin (5-hydroxytryptamine, 5-HT).
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Major depression ▶BY MOUTH ▶Adult: 4 mg twice daily for 3–4 weeks, then increased if necessary to 10 mg daily in divided doses; maximum 12 mg per day
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Bipolar disorder. history of cardiovascular disease. history of epilepsy. prostatic hypertrophy. susceptibility to angle-closure glaucoma. urinary retention Cardiac disease. concurrent electroconvulsive therapy. diabetes mellitus. epilepsy (discontinue if convulsions develop). history of bleeding disorders (especially gastro-intestinal bleeding). history of mania. susceptibility to angle-closure glaucoma CAUTIONS, FURTHER INFORMATION ▶Elderly Prescription potentially inappropriate (STOPP criteria) with current or recent significant hyponatraemia i.e. serum sodium less than 130 mmol/l (risk of exacerbating or precipitating hyponatraemia). See also Prescribing in the elderly p. 33.
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Poorly controlled epilepsy. SSRIs should not be used if the patient enters a manic phase
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→Appendix 1: reboxetine
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▶Common or very common Accommodation disorder. akathisia. anxiety. appetite decreased. chills. constipation. dizziness. dry mouth. headache. hyperhidrosis. hypertension. hypotension. insomnia. nausea. palpitations. paraesthesia. sexual dysfunction. skin reactions. tachycardia. taste altered. urinary disorders. urinary tract infection. vasodilation. vomiting ▶Uncommon Mydriasis. vertigo ▶Rare or very rare Glaucoma ▶Frequency not known Aggression. hallucination. hyponatraemia. irritability. peripheral coldness. potassium depletion (long term use). Raynaud’s phenomenon. suicidal tendencies. testicular pain ▶Common or very common Anxiety. appetite abnormal. arrhythmias. arthralgia. asthenia. concentration impaired . confusion. constipation. depersonalisation. diarrhoea. dizziness. drowsiness. dry mouth. fever. gastrointestinal discomfort. haemorrhage. headache. hyperhidrosis. malaise. memory loss. menstrual cycle irregularities. myalgia. mydriasis. nausea (dose-related). palpitations. paraesthesia. QT interval prolongation. sexual dysfunction. skin reactions. sleep disorders. taste altered . tinnitus. tremor. urinary disorders. visual impairment. vomiting. weight changes. yawning ▶Uncommon Alopecia. angioedema. behaviour abnormal. hallucination. mania. movement disorders. photosensitivity reaction. postural hypotension. seizure. suicidal tendencies. syncope ▶Rare or very rare Galactorrhoea. hepatitis. hyperprolactinaemia. hyponatraemia. serotonin syndrome. severe cutaneous adverse reactions (SCARs). SIADH. thrombocytopenia ▶Frequency not known Withdrawal syndrome SIDE-EFFECTS, FURTHER INFORMATION Symptoms of sexual dysfunction may persist after treatment has stopped. Overdose Symptoms of poisoning by selective serotonin re-uptake inhibitors include nausea, vomiting, agitation, tremor, nystagmus, drowsiness, and sinus tachycardia; convulsions may occur. Rarely, severe poisoning results in the serotonin syndrome, with marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop. For details on the management of poisoning, see Selective serotonin re-uptake inhibitors, under Emergency treatment of poisoning p. 1430.
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Use only if potential benefit outweighs risk— limited information available. Manufacturers advise avoid during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when taken during early pregnancy. If used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported.
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Small amount present in milk—use only if potential benefit outweighs risk.
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Manufacturer advises caution (risk of increased exposure). Dose adjustments Manufacturer advises initial dose reduction to 2 mg twice daily, increased according to tolerance. In general, manufacturers advise caution (prolonged half-life).
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Dose adjustments Initial dose 2 mg twice daily, increased according to tolerance.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Edronax (Pfizer Ltd) Reboxetine (as Reboxetine mesilate) 4 mg Edronax 4mg tablets | Nervous system 60 tablet P £18.91 DT = £18.91 ANTIDEPRESSANTS › SELECTIVE SEROTONIN RE- UPTAKE INHIBITORS Selective serotonin re-uptake f inhibitors
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Caution— avoid abrupt withdrawal. Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck, and spine, tinnitus, sleep Nervous system disturbances, fatigue, influenza-like symptoms, and sweating are the most common features of abrupt withdrawal of an SSRI or marked reduction of the dose; palpitation and visual disturbances can occur less commonly. The dose should be tapered over at least a few weeks to avoid these effects. For some patients, it may be necessary to withdraw treatment over a longer period; consider obtaining specialist advice if symptoms persist. Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more.
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Driving and skilled tasks Counselling advised. Driving and skilled tasks May also impair performance of skilled tasks (e.g. driving, operating machinery). eiiii F 381
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4 mg twice daily for 3–4 weeks, then increased if
First-line fragment. Read the complete Indications and Dose section above.
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