Reboxetine

Reboxetine is a selective norepinephrine reuptake inhibitor (NRI) antidepressant. It inhibits the norepinephrine transporter, increasing synaptic norepinephrine with relatively little effect on serotonin or dopamine at therapeutic doses. It was developed in the 1990s and has been marketed in several European countries under brand names such as Edronax; it is not approved by the United States Food and Drug Administration.

Indication and use: reboxetine is indicated for major depressive disorder in countries where approved. Its use in other conditions is variable and largely off-label or limited by guidelines due to questions about comparative efficacy and tolerability.

Dosing and onset: the usual dose is 4 mg taken twice daily (total 8 mg per day), adjusted for response and tolerability. Onset of antidepressant effects typically occurs over several weeks.

Efficacy and safety: systematic reviews have generally found modest benefit versus placebo, with some trials showing little or no advantage. Adverse effects commonly include dry mouth, constipation, urinary retention, tachycardia, increased sweating, insomnia, and anxiety; blood pressure and heart rate may rise in some patients. Sexual side effects can occur but are considered to be less frequent than with many selective serotonin reuptake inhibitors. Reboxetine should be used with caution in patients with cardiovascular disease or hypertension.

Contraindications and interactions: contraindicated with monoamine oxidase inhibitors; caution with other medications that affect blood pressure or the norepinephrine system. Pregnancy and lactation data are limited; use only if clearly necessary. Discontinuation should be gradual to reduce potential withdrawal symptoms.