From
THE GOOD DRUG GUIDE"....Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in anxiety and mood, noradrenaline is essential to maintaining drive, self-assertiveness and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha 2- and beta-adrenoceptors. Reboxetine itself typically doesn't have the disruptive effects on cognitive function or psychomotor performance common to older, tricyclic clinical mood-brighteners - though alas antimuscarinic effects are still not completely absent. Indeed for one sub-population of depressives, the new NorAdrenaline Reuptake Inhibitors (NARIs) are possibly under-used. Unfortunately, catecholaminergic strategies to combat depression were eclipsed in the late 1980s and 1990s by the marketing hype surrounding selective serotonin reuptake inhibitors (SSRIs).
Reciprocal interactions between the different monoamine systems make it hard to target one neurotransmitter system without triggering a cascade of effects on the others. But NARIs - and "dopaminergics" like amineptine (Survector) - may be especially useful in drive-deficient "anergic" states where the capacity for sustained motivation is lacking; in the treatment of "retarded" depression; and for melancholic depressives with a poor ability to cope with stress. Anxious depressives, on the other hand, may do better on Servier's neuroprotective and anxiolytic antidepressant tianeptine (Stablon), though comparative clinical trials are lacking.
Reboxetine may be safely combined with an SSRI, though there is evidence that NARIs themselves indirectly enhance central serotonin function by a mechanism that doesn't depend on reuptake inhibition. More surprisingly perhaps, preliminary studies suggest reboxetine can actually reverse tranylcypromine-induced hypertensive crises. The "cheese effect" is usually triggered by ingesting tyramine-rich foods. Thus NARIs plus MAOIs may prove a potent form of combination-therapy if other options fail. Newly-licensed (2006) EMSAM, the transdermal selegiline patch, is probably the safest choice of MAOI.
Reboxetine may also be used off-label to treat low back pain, fibromyalgia and obstructive sleep apnea.
By early 2007, reboxetine was licensed worldwide in over 60 countries. In May 2001, however, the FDA declined Pharmacia's license application for the North American market. The grounds for the decision have not been officially disclosed. "
dave@bltc.com
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