Clonidine with Desipramine Interaction Details
Brand Names Associated with Clonidine
- Catapres®
- Clonidine
- Clorpres® (as a combination product containing Chlorthalidone, Clonidine)
- Combipres® (as a combination product containing Chlorthalidone, Clonidine)
- Jenloga®
- Kapvay®
Brand Names Associated with Desipramine
- Desipramine
- Norpramin®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Decreased antihypertensive effectiveness
Interaction Summary
Concomitant clonidine and tricyclic antidepressant (TCA) therapy may impair the antihypertensive effects of clonidine. Tricyclic antidepressants increase the release of noradrenaline, presumably through re-uptake blockade. Clonidine reduces the release of noradrenaline by stimulating pre-synaptic alpha-2 adrenoreceptors, whose function is to inhibit noradrenaline release . Mianserin, a tetracyclic antidepressant, was not shown to exhibit the impairment of clonidine's antihypertensive effects seen with tricyclic antidepressants .
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Blood pressure should be monitored for an appropriate clinical response. Higher doses of clonidine may be required. An alternative class of antihypertensive agents or an alternative class of antidepressants might be considered.
Mechanism Of Interaction
Pharmacological antagonism at central alpha-2 receptors
Literature Reports
A) The interaction between clonidine and desipramine was studied in five hypertensive patients. The results of this double-blind placebo controlled study showed that the introduction of the tricyclic antidepressant led to the loss of blood pressure control in four of the five subjects within two weeks. The rise in the arterial pressure was more prominent in the supine position than in the erect. The average blood pressure increase in the desipramine period compared to the placebo period was 22/15 mm Hg in the lying position and 12/11 mm Hg standing .
B) Eleven drug-free patients who met the Research Diagnostic Criteria for Major Depressive Disorder enrolled in a study to determine the effects of desipramine on central adrenergic function. Patients were given a clonidine infusion after 0, 1 and 3 weeks of treatment with desipramine. Results showed that the sedative and hypotensive effects of clonidine were significantly inhibited after three weeks of treatment with desipramine. This interaction was also seen at one week, but did not reach clinical significance. The authors concluded that the effects that were observed during the study were due to an acute drug effect, rather than to a chronic adaptive change .
C) One case report describes a 65-year-old man who was experiencing perineal pain following the excision of a carcinoma. Pain management of amitriptyline 75 mg nightly and sodium valproate 500 mg three times daily was initiated after slow-release morphine only had a limited effect. A clonidine spinal intrathecal injection of 75 micrograms was given when it was felt that the patient had become tolerant to opioid treatment. Within five minutes, the patient was found to be in severe pain, which resolved within 30 minutes after diamorphine was given. Two mechanisms for this interaction were postulated. In the first, the pain could have been the result of a clonidine-cholinergic interaction. In the second, the tricyclic augmentation of serotoninergic transmission may have unmasked an effect of clonidine at central receptors to enhance nociception .
Clonidine Overview
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Clonidine tablets (Catapres) are used alone or in combination with other medications to treat high blood pressure. Clonidine extended-release (long-acting) tablets (Kapvay) are used alone or in combination with other medications as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) in children. Clonidine is in a class of medications called centrally acting alpha-agonist hypotensive agents. Clonidine treats high blood pressure by decreasing your heart rate and relaxing the blood vessels so that blood can flow more easily through the body. Clonidine extended-release tablets may treat ADHD by affecting the part of the brain that controls attention and impulsivity.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
Desipramine Overview
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Desipramine is used to treat depression. Desipramine is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed for mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.