MAOIs Reboxetine

MAOIs REBOXETINE Risk of severe hypertensive reactions Additive inhibition of norepinephrine reuptake Avoid co-administration. MAOIs should not be started for at least 1 week after stopping reboxetine. Conversely, reboxetine should not be started for at least 2 weeks after stopping MAOIs... 

Reboxetine Reboxetine should not be given, even after termination of MAOI therapy. Care must be exercised when treating with antihypertensive drugs, antiar-rhythmics, cyclosporin, antipsychotics, tricyclics, fluvoxamine, antidepressants, azole antifungals, and macrolide antibacterials. 

The novel compounds nefazodone and trazodone usually require titration to a minimum therapeutic dose of at least 200 mg/day. Response to reboxetine, venlafaxine and mirtazapine may occur at the starting dose but some dose titration is commonly required. Venlafaxine is licensed for treatment-resistant depression by gradual titration from 75 to 375 mg/day. There is some need for dose titration when using MAOIs although recommended starting doses (e.g. phenelzine 15 mg t.d.s.) may be effective. Unlike other drug classes, reduction to a lower maintenance dose is recommended after a response is achieved. 

Reboxetine seems to be an antidepressant that has negligible interference with the pharmacokinetics of other drugs thus, fewer drug-drug interactions are expected. It also may be possible to use reboxetine in combination with MAOIs, because it has no inhibitory effect on this enzyme, which would avoid tyramine-induced hypertensive reactions. 

No data seem to be available about the concurrent use of reboxetine with MAOIs and the manufacturer currently advises the avoidanee of MAOIs because of the potential risk of a tyramine-like eifect [hypertensive crisis]. ... 

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