Formulary
Reboxetine: Indications, Dosing, Side Effects and Interactions
Reboxetine is a selective inhibitor of noradrenaline re-uptake.
MedNext Academy | 3 min read
Reboxetine: Indications, Dosing, Side Effects and Interactions
Reboxetine is a selective inhibitor of noradrenaline re-uptake.
Drug action
Reboxetine is a selective inhibitor of noradrenaline re-uptake.
Indications and dose
**Major depression**
- **Adult** (By Mouth): 18-65 years 4 mg twice daily for 3-4 weeks, then increased if necessary to 10 mg daily in divided doses; maximum 12 mg per day.
Cautions
Bipolar disorder; history of cardiovascular disease; history of epilepsy; prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention
Side effects
Common or very common Accommodation disorder; akathisia; anxiety; appetite decreased; chills; constipation; dizziness; dry mouth; headache; hyperhidrosis; hypertension; hypotension; insomnia; nausea; palpitations; paraesthesia; sexual dysfunction; skin reactions; tachycardia; taste altered; urinary disorders; urinary tract infection; vasodilation; vomiting Uncommon Mydriasis; vertigo Rare or very rare Glaucoma Frequency not known Aggression; hallucination; hyponatraemia; irritability; peripheral coldness; potassium depletion (long term use); Raynaud's phenomenon; suicidal behaviours; testicular pain
Interactions
**Severe interactions:**
- No significant reciprocal pharmacokinetic interaction has been found between reboxetine and lorazepam.
- Food intake delayed the absorption of reboxetine, but did not significantly influence the extent of absorption.
- In an in vivo multiple-dose study performed in healthy volunteers, no clinically significant interaction between fluoxetine and reboxetine was observed.
**Other interactions (19):**
- In vitro metabolism studies indicate that reboxetine is primarily metabolised by the CYP3A4 isozyme of cytochrome P450; reboxetine is not metabolized by CYP2D6.
- Therefore potent inhibitors of CYP3A4 (ketoconazole, nefazodone, erythromycin and fluvoxamine), would be expected to increase plasma concentrations of reboxetine.
- In a study in healthy volunteers, ketoconazole, a potent inhibitor of CYP3A4, was found to increase plasma concentrations of the reboxetine enantiomers by approximately 50%.
- Reboxetine, therefore should not be given together with drugs known to inhibit CYP3A4 such as azole antifungal agents, macrolide antibiotics such as erythromycin, or fluvoxamine.
- Low reboxetine serum levels have been reported with the concurrent administration of CYP3A4 inducers such as phenobarbital and carbamazepine.
- Examples of other CYP3A4 inducers that may reduce the serum levels of reboxetine include but are not limited to phenytoin, rifampicin and St Johns Wort.
Pregnancy
Use only if potential benefit outweighs risk-limited information available.
Breast feeding
Small amount present in milk-use only if potential benefit outweighs risk.
Hepatic impairment
Manufacturer advises caution (risk of increased exposure). Dose adjustments Manufacturer advises initial dose reduction to 2 mg twice daily, increased according to tolerance.
Renal impairment
Dose adjustments Initial dose 2 mg twice daily, increased according to tolerance. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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