Reboxetine: uses and side effects of this drug

Reboxetine is a 4th generation antidepressant drug.. Its mechanism of action involves the selective reuptake of norepinephrine, that is, it is an SNRI (Selective Norepinephrine 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.

• Related article: "Types of antidepressants: characteristics and effects"

Reboxetine: general characteristics

Reboxetine is an antidepressant drug, specifically an SNRI (Selective inhibitor of norepinephrine reuptake). What it does, by blocking the reuptake of norepinephrine, is increase the concentration of norepinephrine in the synaptic cleft (and therefore hence, in the brain), since it has been seen that this substance is greatly decreased in depressed 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.

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

Indications and contraindications

Regarding its indications, reboxetine It 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 responded to treatment initially. As for depression, it is specifically effective for moderate to severe depressive disorders, as well as dysthymic disorder (dysthymia).

It is also indicated for the long-term treatment of children with ADHD (Attention Deficit Disorder with Hyperactivity) who have presented 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 (that is, to its active substance or to any of its excipients). On the other hand, reboxetine It is not recommended in elderly patients, nor in children or adolescents under 18 years of age..

Tradenames

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

4th generation antidepressants

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

Examples of dual antidepressants are venlafaxine (the treatment of choice for Generalized Anxiety Disorder [GAD]) and duloxetine. Also, one 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 (they are the most frequent). Others such as nausea, vomiting, constipation, dry mouth and drowsiness may also appear.

Other effects that may appear, although very rare (affecting between 1/10 in 1,000 patients) are dilated pupils and the sensation of spinning (vertigo).

In the case of children, even if reboxetine is well tolerated (demonstrated in clinical studies), adverse effects such as dizziness, dry mouth, anorexia, and insomnia may appear.

Precautions

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

finally, too precautions should be taken in the case of patients with bipolar disorder, cardiac disorders, glaucoma or urinary retention.

• You may be interested in: "Types of Bipolar Disorder and its characteristics"

Pregnancy and lactation

It is not known exactly what effects reboxetine can have during pregnancy; it is because of that Its use is not recommended if you are pregnant, unless the doctor considers it absolutely necessary. and after having performed a clinical risk/benefit analysis.

Regarding lactation, reboxetine is found in breast milk (in small amounts), so there is a risk of producing an effect on the baby. You should always consult a doctor if you are lactating.

suicide risk

On initial treatment with antidepressants, It has been seen how some of them can produce suicidal ideations; this can also occur with reboxetine.

Patients most at risk are those with a prior history of events related to suicide or a significant degree of suicidal ideation prior to the start of the treatment. For this reason, these types of patients should receive high surveillance during treatment.

This all occurs because the therapeutic effects of antidepressant drugs take time to appear once treatment has started (usually 2 weeks or more). Adverse effects, on the other hand, appear immediately.

Comparison with other psychoactive drugs

Compared with tricyclic antidepressants, reboxetine has been shown to be just as effective for major depression, and more effective than fluoxetine (a type of SSRI) for depressive symptoms related to social functioning (such as 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 Adolescence Psychiatry, 18(1): 53-9.
• Pediamecum. (2015). Reboxetine.
• Stahl, S.M. (2002). Essential Psychopharmacology. Neuroscientific bases and clinical applications. Barcelona: Ariel.
• Vademecum. (2015). Reboxetine.