US Brand Name: Edronax

generic name: reboxetine mesylate

Class: antidepressants. Specifically a Norepinephrine-Selective Reuptake Inhibitors (NSRIs)

1.  Other brand names & branded generic names¹

• Norebox
• Vestra
• reboxetine mesilate (British Commonwealth spelling)

2.  FDA Approved Uses of Edronax (reboxetine mesylate)

Reboxetine isn’t approved for anything in the US. We and Canadia have Strattera instead, which is approved to treat ADD/ADHD in the US. Outside of North America in many places you’d expect to find Strattera, like Australia, Ireland, New Zealand, the UK, you’ll find reboxetine approved to treat depression-spectrum disorders, usually major depressive disorder (MDD).

3.  Off-Label Uses of Edronax (reboxetine mesylate)

• Panic/Anxiety, especially anything having to do with social anxiety/phobia/avoidance
• Adult ADD/ADHD
• Panic disorder in general and SSRI-resistant panic disorder
• Seasonal Affective Disorder (SAD)
• As an add-on to SSRIs for treatment-resistant MDD
• As an add-on to treat schizophrenia
• Eating disorders (Also this tiny study on binge eating and A case report in Portuguese)
• Chronic pain with depression
• Amphetamine withdrawal syndrome
• Cocaine dependence
• LSD-induced Hallucinogen Persisting Perception Disorder with depressive features

4.  Edronax’s (reboxetine mesylate) pros and cons

4.1  Pros

It’s an NSRI, which means:

• Low side effect profile
• No discontinuation syndrome like SSRIs and SNRIs
• It’s less likely to trigger mania in the bipolar than SSRIs

4.2  Cons

• It’s an NSRI, which means that while the side effect profile may be low, one or more of the common side effects is more likely to hang around than is the case with an SSRI, SNRI, or TCA.
• You can’t legally buy it in the US and Canada, and it’s a pain in the ass to legally import it for your own use.
• Even if you can buy it, Edronax comes in one dosage: 4mg. Take it or leave it.
• If you’re bipolar and aren’t stable, even stable in being depressed the same way for months, it’ll destabilize you further.
• And it might be difficult to tell if reboxetine did trigger a mania after all, as one side effect of NSRIs is short-term euphoria without any other symptoms of mania. Making reboxetine and Strattera true “happy pills,” for a little while.

5.  Edronax’s (reboxetine mesylate) Side Effects

5.1  Typical Side Effects

The usual for NSRIs - headache, dry mouth, urinary hesitance, constipation, insomnia/early awakening. The headache tends to go away and only reappears with a dosage increase for most people. The urinary hesitance, dry mouth, constipation and insomnia and/or early awakening can be your constant companions or strike at random throughout the time you take it.

5.2  Not So Common Side Effects

Increased heart rate or heart palpitations. Getting really sweaty. Chills. Like Strattera (atomoxetine) the PI sheets list, and guys have reported temporary and permanent (for as long as you take it) sexual side effects ranging from painful ejaculation to erectile dysfunction. Read about a couple cases of more unusual problems below…

5.3  Freaky Rare Side Effects

This is almost as good as, and obviously related to, Savella’s freaky rare side effect (which is currently The. Best. Freaky Rare Side Effect. Ever.):
Reboxetine induced erectile dysfunction and spontaneous ejaculation during defecation and micturition [urination]. I can’t wrap my head around the concept of simultaneously pissing and coming, but this is an extremely rare as well as freaky side effect, so all you guys into water sports may as well forget about trying to get some reboxetine. If reboxetine is going to mess with your party-time plumbing™, it will probably be more like this guy’s story.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You about Edronax (reboxetine mesylate)

Women may respond to SSRIs better than NSRIs, so this may not necessarily be the best route for girls.

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7.  Reboxetine’s Dosage and How to Take Edronax (reboxetine mesylate)

The recommended initial dose is 4mg twice a day. After three weeks it may be increased to 10–12mg total, however you want to divide your 2.5 to 3 tablets. The optimal dosage is in the range of 8–12mg a day.
As usual we disagree, and suggest starting at 4mg a day, divided in half (the pills are made to be split), maybe even 2mg once a day. Then increase by 2mg a day after two-three weeks as required.

8.  How Long Edronax (reboxetine mesylate) Takes to Work

An average of two weeks in a range of 10 to 30 days.

9.  How to Stop Taking Edronax (reboxetine mesylate)

It’s an NSRI, so if you have the luxury to taper, by all means do so. Reduce the dosage by 4mg a day every 3 days. But if you need to stop immediately, that’s usually not much of a problem. If you do quit cold turkey expect rebound symptoms, which may include panic attacks and short-lived euphoric or dysphoric mania.

10.  Reboxetine’s Half-Life & Average Time to Clear Out of Your System

With a half-life of 12–13 hours, it’s usually cleared in 3–4 days.

11.  Days to Reach a Steady State

Five days.

12.  How Edronax (reboxetine mesylate) Works

Based upon the chemical imbalance theory of brain cooties, reboxetine effectively raises the norepinephrine levels in your brain by letting your synapses soak in norepinephrine for longer than usual by slowing (inhibiting) the mechanism of norepinephrine transmission deeper into the neurons (reuptake).

13.  Comments

I really wish I knew why drug companies didn’t make more norepinephrine-selective reuptake inhibitors (NSRIs). I know I’m not the only person to respond well to them. Let’s ask PubMed…

Reboxetine vs. Zoloft for MDD. Reboxetine was more effective. It may have sucked a little more, but it still worked better.

Reboxetine vs. Effexor They work equally well. Reboxetine is a little faster and, as above, sucks a little more. Although this study was far too brief to take into account having to stop taking either med.

OK, this one is super-specific, so I’m using the actual study title: Reboxetine versus fluvoxamine in the treatment of motor vehicle accident-related posttraumatic stress disorder: a double-blind, fixed-dosage, controlled trial.
Then again, it is an Israeli study, and a huge chunk of the population there has combat PTSD (which responds to meds and talk therapy differently) and similar forms, so I can understand the need for specificity. Reboxetine worked just as well but sucked more. Starting at 8mg a day.

Reboxetine vs. Celexa Celexa worked a little better and, except for sexual side effects, sucked less than reboxetine.

Along similar lines Residual symptoms in depressed patients after treatment with fluoxetine or reboxetine. Reboxetine and Prozac were equally effective, and Prozac sucked less, except for sexual side effects.

Somebody came up with the brilliant idea of treating depression-induced sexual dysfunction with Paxil. Not as some grasping at straws thing, but as a normal course of treatment. If you can get grant money for that then I really need to get better letters after my name. Reboxetine vs. Paxil for fixing sexual dysfunction & MDD. Seriously. Reboxetine wins. I imagine you’re shocked.

Reading all those studies makes it look as if Edronax isn’t worth exploring. Note what they all have in common: everyone started a 8mg a day. No wonder they were all hit with suck-ass side effects. We’re all about start low, titrate slow, and no target dosage.

14.  Discussion board

Crazy Meds’ Edronax discussion board

15.  Your Comments About and Experiences with Edronax

Tell us what you think about Edronax

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Enter your own Comments & Experiences with Edronax here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Edronax Full US Prescribing Information / PI Sheet
Australian Edronax PI
Irish Edronax SPC
Irish Edronax PIL
New Zealand Edronax CMI
New Zealand Edronax MDS Which looks a hell of a lot like a scanned photocopy of an Australian PI.
UK Edronax SPC
UK Edronax PIL

Check for drug-drug interactions

17.  Bibliography

The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl

All those PIs/SPCs listed above.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

Date created 20 Jul 2011 - 18:01 Page Author: JerodPoore Last edited by: JerodPoore

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¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]