The interaction of the selective norepinephrine reuptake inhibitor (2)-reboxetine with the human a4b2 nicotinic acetylcholine receptor (nAChR) in different conformational states was studied by several functional and structural approaches. Patch-clamp and Ca
21-influx results indicate that (2)-reboxetine does not activate ha4b2 nAChRs via interaction with the orthosteric sites, but inhibits agonist-induced ha4b2 activation by a noncompetitive mechanism. Consistently, the results from the electrophysiologybased functional approach suggest that (2)-reboxetine may act via open channel block; therefore, it is capable of producing a usedependent type of inhibition of the ha4b2 nAChR function. We tested whether (2)-reboxetine binds to the luminal [ 3 H]imipramine site. The results indicate that, although (2)-reboxetine binds with low affinity to this site, it discriminates between the resting and desensitized ha4b2 nAChR ion channels. Patch-clamp results also indicate that (2)-reboxetine progressively inhibits the ha4b2 nAChR with two-fold higher potency at the end of one-second application of agonist, compared with the peak current. The molecular docking studies show that (2)-reboxetine blocks the ion channel at the level of the imipramine locus, between M2 rings 69 and 149. In addition, we found a (2)-reboxetine conformer that docks in the helix bundle of the a4 subunit, near the middle region. According to molecular dynamics simulations, (2)-reboxetine binding is stable for both sites, albeit less stable than imipramine. The interaction of these drugs with the helix bundle might alter allostericaly the functionality of the channel. In conclusion, the clinical action of (2)-reboxetine may be produced (at least partially) by its inhibitory action on ha4b2 nAChRs.