Reboxetine

How it works

It selectively inhibits the reuptake of noradrenaline at the presynaptic neuronal membrane, increasing noradrenergic neurotransmission, with little direct effect on serotonin or dopamine reuptake.

Prescribing in practice

• As with all antidepressants, monitor for suicidal thoughts and clinical worsening, particularly early in treatment and in younger adults.
• Common effects include insomnia, sweating, dizziness, dry mouth, constipation and urinary hesitancy, the latter warranting caution in prostatic disease.
• Use caution in cardiac disease, epilepsy and the elderly, and avoid abrupt withdrawal.

Monitoring

Monitor mood, suicidal ideation and tolerability, with attention to blood pressure and urinary symptoms.

Counselling the patient

• It may take a few weeks before you notice an improvement in mood.
• Tell your doctor if you have difficulty passing urine or develop a fast heartbeat.
• Do not stop the medicine suddenly; your doctor will reduce the dose gradually.

Evidence & guidelines

Reboxetine is a licensed antidepressant whose efficacy and place in therapy have been the subject of ongoing evidence review.