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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by erik.mx on June 30, 2000, at 13:04:05
I am about to try Reboxetine after several years of
taking Wellbutrin SR, which doesn't seem to be doing me much good anymore. Does anybody know if I
need a washout period between stopping Wellbutrin and starting Reboxetine? or is it alright to just
make the switch from one day to the next?I know the stock answer is "ask your doctor", but he has left me somewhat confused. Knowing that I
live in Mexico (he is in Los Angeles, CA where I used to live) and knowing that I am not happy with the
Wellbutrin, he suggested I get my hands on Reboxetine, which is no problem here. When I did, I asked
him what dose, washout period etc but his reply was then that he had no info since the med is not
available in the US.Hopefully someone else on here has more info than he does. THANK YOU for any help you can provide,
good people!
Posted by KarenB on June 30, 2000, at 13:33:58
In reply to Switching from Wellbutrin SR to Reboxetine, posted by erik.mx on June 30, 2000, at 13:04:05
Erik,
Don't know about the washout period for Wellbutrin but here's the dosing info on Reboxetine:
http://www.mentalhealth.com/drug/p30-r06.html#Head_3
Karen
Posted by Jonathan on June 30, 2000, at 23:50:34
In reply to Switching from Wellbutrin SR to Reboxetine, posted by erik.mx on June 30, 2000, at 13:04:05
Erik,
Ask your doctor how he'd advise you if you planned only to discontinue Wellbutrin, without replacing it with another medication -- If he were your flying instructor, you'd have a right to be told how to land! Depending on the dose you're taking and various factors from your medical history, he will probably recommend tapering down over several days to one tablet (150 or 100 mg) per day before stopping abruptly. Any withdrawal symptoms during this tapering period are probably due to Wellbutrin's action on dopamine reuptake: they would _not_ be alleviated by simultaneously starting reboxetine at a lower than normal dose, because reboxetine is highly selective for noradrenaline reuptake.
Wellbutrin has a short half-life (21 hours: that's why there's an SR version) so it disappears from your system quickly. It's extensively metabolized, with some breakdown products hanging around for longer and strongly inhibiting cytochrome P450 2D6. This means that any other drug that is broken down by CYP2D6 should be started with caution and at a reduced dose after discontinuing Wellbutrin -- see http://www.rxlist.com/rxboard/wellbutrin.pl?read=707 for a suspected example of this drug interaction.
Fortunately, reboxetine is broken down by CYP3A4, not CYP2D6, so no washout period should be needed -- see
TI: Cytochrome P-450-mediated metabolism of the individual enantiomers of the antidepressant agent reboxetine in human liver microsomes
AU: Wienkers_LC, Allievi_C, Hauer_MJ, Wynalda_MA
NA: PHARMACIA & UPJOHN INC,DRUG METAB & DISPOSIT RES,DEPT DRUG METAB,7265-300-313,301 HENRIETTA ST,KALAMAZOO,MI,49007
JN: DRUG METABOLISM AND DISPOSITION, 1999, Vol.27, No.11, pp.1334-1340, IS: 0090-9556The recommended dose is one 4 mg tablet every 12 hours for the first three weeks, after which you may increase the daily dose from 8 to 10 mg if necessary (The tablets are scored and break cleanly into equal halves containing 2 mg each.) However, if you find the initial side-effects troublesome they may be reduced by taking only 2 mg (half a tablet) every 12 hours for the first week or two: reboxetine has an even shorter half-life (13 hours) than Wellbutrin so you do need to take at least two doses per day.
Because few have made this pioneering transition from Wellbutrin to reboxetine before you, I'd be tempted to be cautious and start with 2 mg 24 hours after the last dose of Wellbutrin, followed by the other half tablet 12 hours later and then 4 mg every 12 hours.
I've been on reboxetine for 11 weeks (7 on 10 mg/day), having made the transition from 225 mg/day Effexor XR approximately as described above: I tapered the dose of Effexor down to 37.5 mg/day over three weeks, no washout period, then 4 mg reboxetine every 12 hours starting 24 hours after the last dose of Effexor. The most significant side-effects were mild flu-like symptoms probably due to venlafaxine withdrawal, which were alleviated by taking one more Effexor tablet without interrupting the 4 mg twice daily doses of reboxetine.
It definitely works for me, but rather slowly: it took about a month to start working and I'm still a long way from complete recovery.
It's a good idea to have your intra-ocular pressure checked while taking reboxetine (the test that oculists administer by blowing a puff of air at your eyeball). The risk of glaucoma is very small, but the symptoms don't become noticeable until too late. The URL posted by KarenB (previous message, I hope) contains good up-to-date information on other possible side-effects and contraindications.
Good luck, and please let us know how you find these two interesting antidepressants compare.
Jonathan.
Posted by erik.mx on July 1, 2000, at 6:06:55
In reply to Re: Switching from Wellbutrin SR to Reboxetine » erik.mx, posted by Jonathan on June 30, 2000, at 23:50:34
Jonathan,
Thank you *very* much for taking the time to give me exactly the information I was looking for. Your help is invaluable, and yes, I will post a followup (or perhaps more than one, if necessary) about my progress. Thank you for sharing your own experience with switching to Reboxetine. Good luck with your recovery.
KarenB, thanks to you also for the link on the dosing (and other) information.
Hopefully, if/when I move back to the US (and far enough from the border to make it impractical to buy the med in Mexico or Canada), the FDA will have approved Reboxetine; else I am looking at making the switch back the other way again, or to something else.
Cheers,
Erik
Posted by Robert on July 2, 2000, at 13:54:54
In reply to Re: Switching from Wellbutrin SR to Reboxetine, posted by erik.mx on July 1, 2000, at 6:06:55
Johnathan, I'm thinking of making the same switch.
I've heard that for men the effect of being chemicaly castrated is all too common with this drug. What has been your experience with this and other side effects?
Robert
Posted by erik.mx on July 2, 2000, at 16:11:21
In reply to Switching from Wellbutrin SR to Reboxetine, posted by erik.mx on June 30, 2000, at 13:04:05
I too am interested in Robert's question. At the site KarenB directed me to, I read that impotence generally occurs at higher frequency with doses exceeding 8 mg/day (4 mg b.i.d). At this time, I don't expect to exceed that level.
My new question, however, is in regards to a second AD that I take, trazodone (Desyrel), to help me sleep. This is in addition to Klonopin, 1 mg h.s., for the same purpose. BTW, *all* these meds are prescribed to help with CFIDS/FM symptoms along with secondary depression. The dosage for the trazodone is low, i.e. 50 mg h.s., vs. the usual 150 to 400 mg/day. (A side note: trazodone is known to cause priapism at higher doses. I was previously taking trazodone at a level of 100 to 150 mg/day and while I did not experience priapism, my libido was signficantly increased, which was fine with me.) If reboxetine has a tendency to cause impotence, is it possible or likely that the trazodone will counteract that?
Is there any other concern I should have about taking reboxetine and trazodone concurrently? At the site KarenB indicated (http://www.mentalhealth.com/drug/p30-r06.html), the following is noted: "Use of reboxetine concomitantly with other antidepressants (tricyclics, MAO inhibitors, SSRIs and lithium) has not been evaluated during clinical studies." Can anybody provide further feedback on the concurrent use of reboxetine and trazodone?
Once again, your input is very much appreciated and useful!
This is the end of the thread.
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