Reboxetine

Reboxetine is one of the newer antidepressants. It belong to a category known as selective norepinephrine reuptake inhibitors (selective NRIs or sNRIs).

Reboxetine selectively and potently inhibits norepinephrine reuptake. In contrast, noradrenergic TCAs, such as desipramine, predominantly inhibit the noradrenergic reuptake transporter but also have a considerable affinity for other receptors. Reboxetine has been shown to have negligible affinity for serotonin and dopamine uptake sites and for adrenergic arid histaminergic receptors, and only weak affinity for muscarinic receptors.

Reboxetine's Efficacy as an antidepressant

A total of 8 randomized, placebo and/or comparator (imipramine, desipramine, and fluoxetine) studies have been conducted in over 2600 patients with major depressive disorder. The results showed that reboxetine is an effective, well-tolerated treatment for the treatment of depression.

The patients treated with reboxetine had a significant improvement of their depression (as measured by the reduction in Hamilton Rating Scale for Depression (HAM-D) score of at least 50%) as compared to those treated with a placebo.

The efficacy of reboxetine has been demonstrated to be comparable to that of other antidepressants. However, more patients responded to reboxetine treatment than to the TCAs and the improvement was better in case of those taking reboxene. Reboxetine was very comparable in the number of patients responding and in mean improvement to the SSRI fluoxetine. However, reboxetine was significantly more effective than fluoxetine; it was as effective as imipramine in treating severe depression.
Reboxetine had much less side effects than SSRIs. Unlike SSRIs, it was found to be effective for the treatment of severe depression. It was also found to be safe for the elderly.

Dosage

Typical: 8-10 mg/day

Side Effects

Being a new drugs, the side effects and drug interaction information is only preliminary.

Selective reuptake inhibitors have an advantage over TCAs in that their mechanism of action is more precise. They are aimed solely at either serotonin or norepinephrine transporters. The knowledge of neurotransmitter pathways in the brain has helped the scientists to predict and explain the consequences of altering serotonin and norepinephrine availability by using such antidepressants. The gastrointestinal disturbances, increased anxiety, and sexual dysfunction associated with SSRIs are side effects caused by the increased levels of serotonin in pathways other than those involved in depression.

Selective NRIs have a totally different profile. They have almost no affinity for serotonin and dopamine uptake sites, or for adrenergic, histaminergic, and muscarinic receptors. So, in theory, the side effects associated with these pathways will be absent in this new class of antidepressants. The only one will be from the blocking norepinephrine reuptake and increasing its availability in the central and peripheral nervous system. This would be expected to result in side effects such as tremor, tachycardia, and urinary hesitancy. Clinical studies were conducted to determine the side effects and safety of reboxetine.

Clinical studies showed that patients experienced only a slightly greater incidence of adverse events when given reboxetine compared with placebo (69% vs. 57%, respectively) and that the Typical side effects are:

(Source: Understanding Depression: A Long term Recurring Disease, The Journal of Clinical Psychiatry, Volume 62, No. 5, May 2001)

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