reboxetine: clinical use

Prescribing considerations

• Assess current and previous suicidal thoughts or behaviour, particularly during early treatment and after prescription changes.
• Review bipolar history because mania or hypomania may occur.
• Use close supervision with seizure history; discontinue if a seizure develops.
• Review urinary retention, prostatic enlargement, glaucoma or raised intraocular pressure, cardiac disease, and medicines that lower blood pressure.
• Exposure increases with renal or hepatic impairment and in older people. The selected SmPC does not recommend use in older patients because controlled safety and efficacy evidence is insufficient.
• The selected SmPC reports clearly demonstrated efficacy only in severe or very severe depression, with limited efficacy data in mild to moderate illness.

Contraindications and cautions

• Hypersensitivity to reboxetine or any product excipient

Monitoring

• Clinical response and worsening depression, suicidality or unusual behavioural change
• Symptoms of serotonin syndrome or mania
• Blood pressure, pulse and postural symptoms where clinically indicated
• Urinary symptoms and signs of raised intraocular pressure
• Potassium where risk factors such as older age or potassium-losing diuretics make this relevant

Clinical pharmacology

A selective noradrenaline-reuptake inhibitor with weak serotonin-reuptake activity and no effect on dopamine uptake. It is principally metabolised through CYP3A4, is highly protein-bound and has increased systemic exposure in renal or hepatic impairment and older age.

Formulation and product differences

• The selected product is an oral, white, round, scored tablet that can be divided into equal halves.

Tablet

Route: Oral

Strengths: 4 mg