Reboxetine


  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.


  Interaction(s) with Common Anaesthetic Agents


None1, 2, 3, 4.


  Interaction(s) with other Common Medicines used in the Perioperative Period


Hypertensive Crisis

Concomitant use of monoamine oxidase (MAO) inhibitors, including linezolid1 and methylthioninium chloride (methylene blue)2, 3 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 reboxetine1. Due to its narrow therapeutic index concomitant use is not recommended by the manufacturer2; however, this seems an overly cautious approach3.

Whilst single surgical prophylactic doses should not pose a problem, a reboxetine dose reduction may be necessary if prolonged treatment is required3.


  Further Information


Withdrawal

Abrupt cessation of reboxetine is not recommended1. 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 reports2.

Hypokalaemia

Reduced plasma potassium concentrations have been seen in elderly patients after prolonged use2. Concomitant use of diuretics may increase the risk of hypokalaemia2, 3.


  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th July 2019]
  2. 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]
  3. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th July 2019]
  4. 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]