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A possible clonidine-trazodone-dextroamphetamine interaction in a 12-year-old boy
V S Bhatara1, B R Kallepalli, L K Misra
1Department of Psychiatry, University of South Dakota School of Medicine, Sioux Falls 57117-5039, USA.
Insights
A child experienced syncope after a trazodone dose increase. This highlights a potential pharmacodynamic interaction between trazodone and clonidine, especially when taken on an empty stomach.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Clinical Toxicology
Background:
- Concurrent use of dextroamphetamine, clonidine, and trazodone for insomnia in a pediatric patient.
- Recurrence of insomnia prompted a dose increase of trazodone from 50 mg to 100 mg.
Observation:
- A 12-year-old boy experienced syncope, hypotension, bradycardia, and sedation within 45 minutes of taking an increased trazodone dose on an empty stomach.
- The adverse event occurred while on a treatment regimen including dextroamphetamine, clonidine, and trazodone.
Findings:
- The syncopal episode is likely due to a pharmacodynamic interaction between clonidine and trazodone.
- Rapid absorption of the increased trazodone dose on an empty stomach may have aggravated the interaction.
- The role of dextroamphetamine in this specific event is considered less likely.
Implications:
- Concurrent administration of trazodone and clonidine requires careful dose titration and monitoring of vital signs.
- Administering trazodone on an empty stomach, particularly during dose escalation, should be avoided.
- Clinicians must be aware of the potential for trazodone to cause hypotension and sedation, especially when combined with other agents like clonidine.
Abstract:
A 12-year-old boy on a dextroamphetamine-clonidine-trazodone treatment regimen had a recurrence of insomnia, and his bedtime trazodone dose was doubled from 50 mg to 100 mg. Within 45 mins after taking the first 100-mg trazodone dose on an empty stomach, the patient had a syncopal episode associated with hypotension, bradycardia, and sedation. The drug reaction could have resulted from either trazodone or clonidine, but it is more likely to have resulted from a pharmacodynamic clonidine-trazodone interaction, presumably aggravated by rapid absorption (on an empty stomach) of a recently increased dose of trazodone. It is conceivable but less likely that the psychostimulant was a clinically significant factor. However, a drug interaction between clonidine and D-amphetamine does not need to be postulated to explain this child's syncopal reaction. The authors advise that (1) if trazodone and clonidine are used concurrently, the doses of both agents should be changed slowly, (2) blood pressure and pulse should be carefully monitored at baseline and then periodically during treatment, and (3) administration of trazodone on an empty stomach, and especially dose increases on an empty stomach, should be avoided. Physicians should remain aware that trazodone has the potential to produce hypotension and sedation, especially when combined with other agents (such as clonidine) that might produce the same adverse effects.