Reboxetine is a 4th generation antidepressant drug Its mechanism of action involves the selective reuptake of noradrenaline, that is, it is an SSRI (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 effectiveness with other antidepressants to treat depression.
Reboxetine is an antidepressant drug, specifically an SSRI (Selective norepinephrine reuptake inhibitor). What it does, by blocking the reuptake of norepinephrine, is to increase the concentration of norepinephrine in the synaptic space (and therefore, in the brain), since it has been seen that this substance is greatly decreased in depressive patients, as is the serotonin and dopamine.
It is considered a 4th generation antidepressant (the first SNRI), highly selective and very powerful. 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 initially responded to treatment. Regarding depression, specifically it is 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 little 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 ingredient or to any of its excipients). On the other hand, reboxetine It is not recommended in elderly patients, 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 along with dual antidepressants, that is, drugs that inhibit the reuptake of both serotonin and norepinephrine (SNRI).
Examples of dual antidepressants are venlafaxine (treatment of choice for Generalized Anxiety Disorder (GAD)) and duloxetine. Furthermore, 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 (they are the most frequent). Others may also appear such as nausea, vomiting, constipation, dry mouth and drowsiness.
Other effects that may appear, although very rare (affecting between 1/10 of every 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.
On the other hand, some antidepressants such as reboxetine have caused seizures in clinical trials, so great caution should also be taken in the case of patients with a history of seizure disorders. Drug treatment should be stopped if the person experiences seizures at any time.
Finally, also Precautions should be taken in patients with bipolar disorder, cardiac disorders, glaucoma or urinary retention
Pregnancy and lactation
It is not known exactly what effects reboxetine may 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 breastfeeding, reboxetine is found in breast milk (in small quantities), so there is a risk of producing an effect on the baby. You should always consult a doctor if you are breastfeeding.
Suicide risk
In initial treatment with antidepressants, It has been seen how some of them can produce suicidal ideations ; This can also occur with reboxetine.
Patients who are most at risk are those with a previous history of events related to suicide or with a significant degree of suicidal ideation prior to the start of treatment. This is why these types of patients must receive high surveillance during treatment.
All of this occurs because the therapeutic effects of antidepressant drugs take time to appear once treatment has started (generally 2 weeks or more). The adverse effects, however, appear immediately
Comparison with other psychotropic drugs
Compared to tricyclic antidepressants, reboxetine has been shown to be equally effective for major depression, and more effective than fluoxetine (a type of SSRI) for depressive symptoms related to social functioning (such as avolition).
