Rimonabant Antidepressants

Ketoconazole doubled the AUC of rimonabant, and other potent CYP3A4 inhibitors are also expected to raise rimonabant levels. Potent CYP3A4 inducers are expected to lower rimonabant levels. Due to a lack of information the manufacturers suggest that rimonabant should not be taken with antidepressants. Rimonabant does not appear to affect the levels of oral contraceptives, di-goxin, midazolam or warfarin, and alcohol, lorazepam, and orlistat do not appear to alter rimonabant levels. 

The adverse effects of rimonabant are upper respiratory tract infections, nausea, dizziness, and insomnia. The focus has, however, particularly been on mood alterations, depressive disorders, and anxiety, and these symptoms were reported in 3.2% with rimonabant (20 mg) and in 1.6% in placebo-treated patients. Patients with psychiatric illnesses were, however, not included in the published rimonabant trials. Thus, there is limited data available on the safety of rimonabant in patients with mental illness. Therefore, the use of rimonabant is not recommended in patients with depression or in patients on antidepressant medication. 

Sibutramine may be useful in patients where the obese state is characterised by overeating and snacking because of its appetite reducing effects. Sibutramine should not be used in patients with uncontrolled hypertension or with tachy-arrhythmia. Rimonabant may be preferred in obese patients with the metabolic syndrome particularly in those with low HDL and high triglyceride. Because of few data rimonabant should be avoided in patients with psychiatric illness, particularly in patients with major depressions and in patients in antidepressive treatment. These suggestions are not evidence based but the recommendations that can be used until more direct head-to-head investigations have been performed. 

Depressive disorders and mood alterations are common in patients taking rimonabant. The manufacturers say that as there is limited experience in using rimonabant with antidepressants, and concurrent use is not recommended. ... 

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