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Issues for surgery

Risk of withdrawal symptoms if omitted (see Further information).

Advice in the perioperative period

Elective and emergency surgery

Continue.

Post-operative advice

If a long nil by mouth (NBM) period is anticipated, or if there are concerns with enteral absorption, advice on alternative preparations/routes should be sought from a psychiatrist.

Interactions with common anaesthetic agents

None.

Interactions with other common medicines used in the perioperative period

Hypertensive crisis

Concomitant use of monoamine oxidase inhibitors (MAOIs), including linezolid and methylthioninium chloride (methylene blue) should be avoided in view of the potential risk of hypertensive crisis.

Clarithromycin

CYP3A4 inhibitors (e.g. clarithromycin) are predicted to increase the exposure to reboxetine. Due to its narrow therapeutic index concomitant use is not recommended by the manufacturer. However, this seems an overly cautious approach.

Whilst single surgical prophylactic doses should not pose a problem, a reboxetine dose reduction may be necessary if prolonged treatment is required.

Further information

Withdrawal

Abrupt cessation of reboxetine is not recommended. In post-marketing experience there have been a few reports of withdrawal symptoms (including headache, dizziness and nausea). However, no consistent pattern of events was evident in the reports.

Hypokalaemia

Reduced plasma potassium concentrations have been seen in elderly patients after prolonged use. Concomitant use of diuretics may increase the risk of hypokalaemia.

References

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th July 2019]

Summary of Product Characteristics – Edronax® (reboxetine) 4mg Tablets. Pfizer Limited. Accessed via www.medicines.org.uk 18/07/2019 [date of revision of the text October 2015]

Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th July 2019]

Reboxetine. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. Electronic version. Truven Health Analytics, Greenwood Village, Colorado, USA. Available at: http://www.micromedexsolutions.com. [Accessed 18th July 2019]