Drug Interactions and Management

Introduction to Key Concerns

The American Academy of Child and Adolescent Psychiatry recommends obtaining a detailed cardiac history before initiating clonidine, including family history of sudden death, repeated fainting, or arrhythmias, as clonidine can cause bradycardia, hypotension, and rarely AV conduction abnormalities 1
The American Academy of Child and Adolescent Psychiatry suggests that the rate of cardiovascular side effects with clonidine is rare to infrequent (less than 1/100), but serious events including complete AV block have been documented when combined with other cardiac-active medications 1

The American Academy of Child and Adolescent Psychiatry recommends obtaining baseline cardiovascular assessment, including detailed personal and family cardiac history, baseline heart rate and blood pressure, and considering baseline ECG if cardiac risk factors are present 1
The American Academy of Child and Adolescent Psychiatry advises starting clonidine at the lowest dose (0.05 mg at bedtime) and increasing slowly, never exceeding 0.3 mg/day 1, 3
The American Journal of Obstetrics and Gynecology suggests titrating atomoxetine cautiously in the presence of clonidine, starting at 40 mg daily and adjusting every 7-14 days 4, 5, 6
Clinical Infectious Diseases recommends maintaining stable lamotrigine dosing unless seizure control or mood symptoms require adjustment, and notes that lamotrigine requires therapeutic drug monitoring when combined with medications that induce hepatic enzymes 2

The American Academy of Child and Adolescent Psychiatry recommends exercising extreme caution when using clonidine in patients with AV conduction disease, and notes that rebound hypertension can occur if clonidine is abruptly discontinued 1
The American Academy of Child and Adolescent Psychiatry suggests that pediatric patients are the most common population to use this combination, and that patients with hepatic insufficiency may require lower doses and more frequent monitoring 1