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Rebound hypertension following withdrawal of clonidine

Consultant in Child and Adolescent Psychiatry, Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN

Rahul Srivastava

Locum Senior House Officer in Psychiatry, Cardiff, email: drrahuls{at}gmail.com

We report a 15-year-old girl with mild intellectual disability and Tourette's syndrome who also had features of hyperkinetic disorder. She had responded poorly to earlier trials of haloperidol and methylphenidate and was on 300 µg clonidine twice a day, 2 mg risperidone daily, 20 mg citalopram daily and 2 mg lorazepam a day. However, these medications were having minimal effects on her behaviour and her tics were also uncontrolled.

With no fixed protocol for clonidine withdrawal an enquiry was made to the hospital pharmacy and the manufacturer who suggested a withdrawal rate of 50 µg every third day. A week after the withdrawal regimen she was admitted as an emergency to the children's ward with symptoms of blurred vision and high blood pressure. All investigations were normal except for elevated cholesterol and triglyceride levels.

A literature search did not yield any results for a safe rate of clonidine withdrawal to avoid the potentially dangerous side-effects of rebound hypertension in children. The manufacturer, Boehringer Ingelheim, informed us that there were no recommendations for withdrawing clonidine apart from the fact that it has to be withdrawn gradually.

Since clonidine is used in children and young people to treat tic and conduct disorders, sleep disturbances, post-traumatic stress disorder, developmental delay and attention-deficit hyperactivity disorder (Hart-Santora & Hart, 1992; Steingard et al, 1993; Singer et al, 1995), there is a need for a safe protocol that highlights the need for gradual withdrawal.

References

HART-SANTORA, D. & HART, L. L. (1992) Clonidine in attention deficit hyperactivity disorder. Annals of Pharmacotherapy, 26, 37 -39.[Medline]

SINGER, H. S., BROWN, J., QUASKEY, S., et al (1995) The treatment of attention deficit hyperactivity disorder in Tourette's syndrome; a double-blind placebo controlled study with clonidine and desipramine. Journal of Paediatrics and Child Health, 95, 74 -81.

STEINGARD, R., BEIDERMAN, J., SPENCER, T., et al (1993) Comparison of clonidine response in the treatment of attention deficit hyperactivity disorder with and without comorbid tic disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 350 -353.[Medline]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ahuja, A. S. Articles by Srivastava, R. Search for Related Content PubMed Articles by Ahuja, A. S. Articles by Srivastava, R.