Reboxetine: uses and side effects of this drug

This psychopharmaceutical belongs to the group of ISRN-type antidepressants. Let's see what it looks like.

Reboxetine is a 4th generation Antidepressant drug.. Its mechanism of action involves the selective reuptake of noradrenaline, i.e. it is a SNRI (selective noradrenaline reuptake inhibitor).

In this article we will see what uses this drug has in clinical practice, general characteristics, contraindications, adverse effects and comparison of its efficacy with other antidepressants to treat depression.

Reboxetine: general characteristics

Reboxetine is an antidepressant drug, specifically an SNRI (Selective Serotonin Reuptake Receptor Inhibitor). (selective norepinephrine reuptake inhibitor). What it does, by blocking the reuptake of noradrenaline, is to increase the concentration of noradrenaline in the synaptic space (and therefore in the brain), since it has been seen that this substance is greatly diminished in depressive patients, as well as serotonin and dopamine.

It is considered a 4th generation antidepressant (the first ISRN), highly selective and very potent. It was approved in many European countries in the late 1990s as a treatment for depression.

In addition, it has a weak effect on reuptake, it has a weak effect on serotonin (5-HT) reuptake and does not affect dopamine uptake.. It is generally used as an adjunct to SSRIs (Selective Serotonin Reuptake Inhibitors).

Indications and contraindications

Regarding its indications, reboxetine is indicated for the acute treatment of major depressive disorders. (and other depressive disorders) and for the maintenance of clinical improvement in patients who have initially responded to treatment. For depression, it is specifically effective for moderate to severe depressive disorders, as well as for dysthymic disorder (dysthymia).

It is also indicated for the long-term treatment of children with ADHD (Attention Deficit Hyperactivity Disorder) who have shown poor response or poor tolerance to initial treatment with methylphenidate (psychostimulant). Finally, it is also indicated in some cases of panic disorder.

On the other hand, it is contraindicated in patients with hypersensitivity to reboxetine itself (i.e. to its active ingredient or to any of its excipients). On the other hand, reboxetine is not recommended in elderly patients, nor in children or adolescents under 18 years of age..

Trade names

Reboxetine is marketed in drugs under different trade names: Davedax, Edronax, Norebox and Solvex..

4th generation antidepressants

As we have seen, reboxetine is considered a 4th generation antidepressant, together with other SNRIs and with dual antidepressants, i.e. drugs that inhibit the reuptake of both serotonin and norepinephrine (SNRIs).

Examples of dual antidepressants are venlafaxine (treatment of choice for Generalized Anxiety Disorder [GAD]) and duloxetine. In addition, an advantage of duals is that they do not affect adrenaline or histamine, producing fewer side effects than other types of antidepressants.

Side effects

The main side effects that reboxetine can produce are: abdominal pain, headaches and decreased appetite (these are the most frequent). (these are the most frequent). Others may also appear such as nausea, vomiting, constipation, dry mouth and drowsiness.

Other effects that may occur, although very infrequent (affecting 1/10 of every 1,000 patients) are dilated pupils and the sensation of spinning (vertigo).

In children, although reboxetine is well tolerated (demonstrated in clinical studies), adverse effects such as dizziness, dry mouth, anorexia and insomnia may occur.

Precautions

On the other hand, some antidepressants such as reboxetine have produced convulsions in clinical trials.Therefore, caution should also be exercised in patients with a history of seizure disorders. Drug treatment should be discontinued if the person presents seizures at any time.

Finally, caution should also be exercised in patients with a history of seizure disorders. precautions should be taken in the case of patients with bipolar disorder, cardiac disorders, glaucoma or urinary retention..

Pregnancy and breastfeeding.

It is not known exactly what effects reboxetine may have during pregnancy; this is why its use is not recommended if you are pregnant, unless the doctor considers it absolutely necessary and after a clinical risk/benefit analysis has been carried out.

Regarding breastfeeding, reboxetine is found in breast milk (in small amounts), so there is a risk of producing an effect on the baby. A physician should always be consulted in case of breast-feeding.

Suicide risk

In the initial treatment with antidepressants, Some antidepressants have been shown to produce suicidal ideation.This may also occur with reboxetine.

The patients most at risk are those with a previous history of suicide-related events or with a significant degree of suicidal ideation prior to the start of treatment. This is why these types of patients should receive high vigilance during treatment.

This is because the therapeutic effects of antidepressant drugs take time to appear once treatment is initiated (usually 2 weeks or more). Adverse effects, on the other hand, appear soon after the start of treatment..

Comparison with other psychotropic drugs

In comparison with tricyclic antidepressants, reboxetine has been shown to be as effective as tricyclic antidepressants for major depression, and more effective than fluoxetine (a type of SSRI) for depressive symptoms related to social functioning (e.g. abulia).

Bibliographic references:

• Arabgol, F., Panaghi, L. and Hebrani, P. (2009). Reboxetine versus methylphenidate in the treatment of children and adolescents with attention deficit-hyperactivity disorder. Eur Child Adolesc Psychiatry, 18(1): 53-9.
• Pediamécum. (2015). Reboxetina.
• Stahl, S.M. (2002). Psicofarmacología esencial. Bases neurocientíficas y aplicaciones clínicas. Barcelona: Ariel.
• Vademecum. (2015). Reboxetina.