Reboxetine (Edronax, Norebox, Prolift, Solvex, Vestra)
Reboxetine is a new type of antidepressant that works primarily on norepinephrine instead of on serotonin. It is not available in the United States.
The Bottom Line: What You Really Need to Know
- Reboxetine is used to treat depression, narcolepsy, panic attacks and chronic pain.
- The usual dose is 4 mg twice a day. It can be increased to 10 mg/day total dose if necessary.
- Reboxetine may interact with other medications. Make sure your doctor and pharmacist know about all of the medications you take, including over-the-counter medications, herbal remedies, homeopathic remedies, vitamins, supplements and medications you only take occasionally.
- It will probably be a week or two before you notice any difference in the way you feel.
- Don't stop taking reboxetine suddenly; the dose must be tapered gradually or you may experience withdrawal symptoms.
- Most people have a few mild side effects, like dry mouth or constipation, when they start taking reboxetine. They usually go away with time.
- Have a friend or family member check in with you every day for the first few weeks you take reboxetine. Ask him or her to help monitor your condition for
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
Uses
Reboxetine is used to treat depression. It is also effective for narcolepsy, panic disease and chronic pain. It is helpful for treating people who have Parkinson's disease and depression.
Dosage and instructions
The initial dose of reboxetine is 4 mg twice a day. After 3 weeks it can be increased to a total of 10 mg/day if needed. It takes two weeks or more for the full effect to be felt.
Elderly people should begin with 2 mg twice a day, which can be increased to a total of 6 mg/day after three weeks if necessary.
The dose should be decreased in people with liver or kidney disease.
How reboxetine works
Depression is thought to be caused by imbalances in neurochemicals at the nerve endings. Reboxetine increases the amount of norepinephrine by preventing its reabsorption. Norepinephrine may be involved in maintaining drive, vigilance, attention and motivation, which are often diminished in depression.
Reboxetine has little or no effect on other neurotransmitters.
Side effects
The side effects that can occur with reboxetine are:
- Dry mouth
- Constipation
- Headache
- Drowsiness or insomnia
- Dizziness
- Sweating
- High blood pressure
- Loss of appetite
- Sexual problems
- Difficulty urinating
- Allergic reactions
- Palpitations
Interactions
It is not clear which medications actually interact with reboxetine and which ones could interact with it on the basis of chemistry. The list of medications that may cause interactions includes:
- Papaverine-a vasodilator
- Antifungals such as ketoconazole, fluconazole, itraconazole and voriconazole
- Bosentan (Tracleer)-for the treatment of pulmonary hypertension
- Certain antibiotics such as erythromycin, clarithromycin or troleandromycin
- SSRI antidepressants
- Medications for heart dysrhythmias like amiodarone, diltiazem, verapamil, quinidine
- Imatinib (Gleevec)-a cancer medication
- MAOI antidepressants
- Seizure medications
- Antivirals like nelfinavir, ritonavir, saquinavir, efavirenz, delavirdine, nevirapine
- Rafampin and rifabutin-tuberculosis medications
- St. John's wort
- Zafirlukast (Accolate)-asthma medication
- Cyclosporine and tacrolimus-transplant medications
- Lorezapam (Ativan)
On the other hand, some sources say that reboxetine can safely be used to augment SSRI antidepressants because they do not interact. Some say that reboxetine could even be safe to take with MAOI antidepressants and could be used to augment them.
Withdrawal
Robexetine should not be discontinued abruptly; the dose should be tapered gradually over several weeks.
Warnings, precautions and contraindications
Suicide risk: There is an increased risk of suicide with all antidepressants. Careful monitoring is necessary during the first several weeks of therapy that includes weekly physician or therapist visits and daily observation by friends or family. Any unusual symptoms, mood changes, behaviors or thoughts should be reported immediately to the physician.
MAOIs: It is not known if reboxetine interacts with MAOIs like other antidepressants. The interaction with MAOIs can be very serious and can result in death, so it is recommended that reboxetine not be taken within two weeks of taking a MAOI antidepressant.
Mania: Reboxetine can trigger manic episodes in people who have bipolar disease. The mania can be severe and can include rapid cycling and psychotic features.
Reboxetine has the potential to cause seizures and should not be taken by people who have a seizure disorder.
Reboxetine should be used with caution in people who have glaucoma or an enlarged prostate.
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