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Re: SNRIs: Desipramine vs. Reboxetine

Posted by SLS on April 16, 2002, at 22:18:03

In reply to Re: SNRIs: Desipramine vs. Reboxetine » fachad, posted by mat on April 16, 2002, at 17:09:51

> hi fachad
> everything you posted is of course true and is exactly what my pharmacology-textbooks says, but remember:
> 1. the affinity of desipramine for muscarinic receptors is about 34 times higher
> 2. for h1-receptors about 3 times higher
> 3. for alpha1-receptors about 90 times higher
> maybe that makes the difference, and is the reason for the hype (is there really a hype about reboxetine? and-do you know any reasons why the fda rejected its approval?)
> thank's for your reply
> mat


Hi Mat.

The manufacturer of reboxetine presented the FDA with plenty of statistics from the clinical trials it performed in Europe. However, the FDA required that they contribute numbers produced by trials performed in the US. Unfortunately for the manufacturer, the investigation they performed ended up being a "failed" study. The results of a placebo-controlled investigation of reboxetine versus fluoxetine showed neither drug to be more effective than placebo. Since fluoxetine *is* more effective than placebo, these results were meaningless, and another lengthy series of trials would be required by the FDA. This was several years ago. I don't know what has been going on more recently.

I know I say this all the time, but I don't think it makes sense to use in simplistic fashions the known properties of prospective antidepressants to deduce their potential effectiveness. There's just too much going on in there. Empirical observation is still the only reliable way to screen for effective drugs.

I don't think much of reboxetine in general, but I'm sure there are people for whom it is a miracle drug.


- Scott

 

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