reboxetine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
reboxetine: clinical details
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.
reboxetine preparations and strengths
Tablet
Route: Oral
Strengths: 4 mg
reboxetine interactions
Tell the prescriber or pharmacist about prescription, non-prescription and herbal products. Important interactions include:
Potent CYP3A4 inhibitors, including azole antifungals, macrolide antibiotics and fluvoxamine
These can increase reboxetine concentrations; the selected SmPC says they should not be given together.
CYP3A4 inducers, including carbamazepine, phenobarbital, phenytoin, rifampicin and St John’s wort
These may reduce reboxetine concentrations and potentially reduce its effect.
Serotonergic medicines, including SSRIs, SNRIs, tricyclic antidepressants, lithium, triptans, buspirone, tryptophan and some opioids
Combining them can increase the risk of serotonin syndrome and requires careful clinical review.
Sources
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Record learning (opens in a new tab)Prepared and reviewed by the iatroX editorial team.