Issues for Surgery
Risk of withdrawal symptoms if omitted (see Further Information).
Advice in the Perioperative period
Elective and Emergency Surgery
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
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.
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.
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.
Reduced plasma potassium concentrations have been seen in elderly patients after prolonged use2. Concomitant use of diuretics may increase the risk of hypokalaemia2, 3.