NARI - NorAdrenaline Reuptake Inhibitor (Wiki)

Also referred to as a Noradrenaline Reuptake Inhibitor (NRI)
Also referred to as a Specific Noradrenaline Reuptake Inhibitor (SNRI)

Please note: Dosage equivalents are provided for certain drugs below and are denoted as unit equivalents, i.e. one unit of drug x is roughly the equivalent as one unit of drug y, where the dosage equal to one unit varies.

NARI drugs specifically target the monoamine neurotransmitter noradrenaline, which is also (internationally) referred to as norepinephrine, the former being a specifically British term. They inhibit the reuptake of said compound, thereby increasing the amount of noradrenaline available to the brain resulting in an antidepressant effect.

Typically speaking, NARI medications are less effective than SSRI medications in combatting obsessive compulsive disorders, major depressive disorders, panic disorders and obsessive symptoms in general.

However, NARI drugs tend to augment the therapeutic effect of other selective reuptake inhibitors, especially SSRIs; a combination of the two can prove very effective. Another theoretically beneficial combination can be made with SDRI medications.


Atomoxetine (Tomoxetine) (Wiki)

Brand names: Strattera®
Formula: C17H21NOHCl
Half life: ~ 5 hours
Single unit dose: Unknown
Recommended outpatient dose: 80mg per day [Not Verified]
Maximum outpatient dose: 100mg per day [Not Verified]

Although atomoxetine was originally developed as an antidepressant, research has indicated that the antidepressant affect of the drug is negligible, contrary to popular belief; it is instead used to treat attention-deficit hyperactivity disorder (ADHD) in children. It is listed here for the sake of completeness.

Desipramine (Wiki)

Brand names: Norpramin®, Pertofrane®
Formula: C18H22N2
Half life: ~ 21 hours
Single unit dose: Unknown
Recommended outpatient dose: 150mg per day [Not Verified]
Maximum outpatient dose: 300mg per day [Verified]

Desipramine is also known and classified as a tricyclic antidepressant, meaning that the chemical structure of the drug consists of three rings.

This drug inhibits the reuptake of the monoamine neurotransmitter noradrenaline. As with other similar antidepressants, desipramine has proven useful in the treatment of neuropathic pain; it may also be beneficial in the treatment of ADHD.

Maprotiline (Wiki)

Brand names: Deprilept®, Ludiomil®, Psymion®
Formula: C20H23N
Half life: ~ 43 hours
Single unit dose: Unknown
Recommended outpatient dose: 75mg per day [Not Verified]
Maximum outpatient dose: 225mg per day [Verified]

Maprotiline is also known and classified as a tetracyclic antidepressant, meaning that the chemical structure of the drug consists of four rings. Although it is classified as an NARI, it does influence both serotonin and dopamine, but not to any significant extent.

This particular medication is strongly sedative; this effect will be felt right from the very start of treatment, whilst the antidepressant effect may take as long as four weeks to become apparent (although an interim period as short as one week is not uncommon). This sedative quality lends itself well to anxiety disorders and insomnia, which often go hand in hand with depressive disorders.

Unfortunately, Maprotiline is unsuitable for pregnant women due to the risk of the child suffering from delayed bone development; nurse feeding mothers should not take the drug either, as it may have a harmful affect upon the child via breast milk. It should also be used with caution in patients with known or suspected convulsive disorders as it is known to promote the onset of seizures in susceptible subjects. Concurrent use with ECT is also hazardous.

The most common side effects are the stated sedation, a dry mouth, vertigo, blurred vision, constipation, headaches and nervousness. Unfortunately, if you choose to take Maprotiline, regular and frequent blood tests will be advised; you may also be asked to undergo regular EEG tests. Patients with a psychotic illness may want to give this one a miss as it can aggravate psychotic symptoms.

Reboxetine (Wiki)

Brand names: Edronax®, Norebox®, Prolift®, Solvex®, Vestra®
Formula: C19H23NO3
Half life: ~ 13 hours
Single unit dose: Unknown
Recommended outpatient dose: 4mg per day [Verified]
Maximum outpatient dose: 12mg per day [Verified]

A relatively modern medication, Reboxetine is fast proving its worth in the treatment of depressive disorders. One particular trait worth mentioning is its ability to compliment SSRI drug therapy safely, typically increasing the antidepressant qualities that both drug possess. Reboxetine typically takes approximately two weeks to present the patient with an antidepressant effect.

Compared to most antidepressants, Reboxetine has a low side effect profile and is generally considered to be a comparatively safe drug to administer. The most common side effects reported are a dry mouth, constipation, insomnia, excessive sweating, vertigo and urinary hesitance and/or retention; impotence may be experienced as well, but is uncommon in doses south of 8mg per day.

Generally, side effects generally recede during the first four to eight weeks of therapy. Discontinuation (withdrawal) of the drug only causes adverse effects in 4% of patients; interestingly, patients treated with a placebo had a 6% chance of experiencing adverse effects. However, Reboxetine can be hazardous in patients exhibiting a bipolar disorder, magnifying the manic stage to a distressing extent.

At the time of writing, Reboxetine is not available to patients within the USA.

Viloxazine (Wiki)

Brand names: Emovit®, Vivalan®, Vivarint®, Vicilan®
Formula: C13H19NO3
Half life: ~ 3.4 hours
Single unit dose: Unknown
Recommended outpatient dose: 100mg per day [Not Verified]
Maximum outpatient dose: 300mg per day [Not Verified]

Viloxazine is also known and classified as a bicyclic antidepressant, meaning that the chemical structure of the drug consists of two rings. It has been studied for use as a treatment for enuresis (bed-wetting), narcolepsy and alcoholism fairly successfully (suggesting that it exerts a urinary hesitance and/or retention quality as well as a stimulant effect). Conversely, the drug has been shown to be comparatively ineffective in the treatment of dysthymia.

Side effects include the two obvious symptoms of insomnia and urinary hesitance and/or retention, nausea and/or vomiting, changes in appetite (usually a loss of appetite), epigastric pain, diarrhoea, confusion and psychomotor agitation.

Due to the stimulant effect, this drug should not be taken any later than 6pm. Typically, viloxazine takes approximately two weeks to start delivering any antidepressant effect, but as with all medications, this is subjective.

This medication has been discontinued within the United Kingdom.