Maprotiline Clonidine

The antihypertensive effects of clonidine are reduced by about 50% when it is co-administered with clomipramine or desipramine. The antihypertensive effects of guanethidine can be reduced by doxepin, amitriptyline, or desipramine, but not by maprotiline. 

The tricyclic antidepressants, clomipramine, desipramine and imipramine, reduce or abolish the antihypertensive effects of clonidine. Other tricyclics are expected to behave similarly. A hypertensive crisis developed in a woman taking clonidine who was also given imipramine, and severe pain ocenrred in a man taking amitriptyline and diamorphine when he was given intrathecal clonidine. Conversely, the tetracyclics, maprotiline and mianserin do not appear to alter the antihypertensive effects of clonidine. An isolated case report describes a hypertensive crisis in a patient taking mirtazapine and clonidine. Hypotension ocenrred in a boy taking clonidine and trazodone. 

The interaction between clonidine and the trieyelics is established and clinically important. The incidence is uncertain but it is not seen in all patients. Avoid concurrent use unless the effects can be monitored. Increasing the dosage of clonidine may possibly be effective. The clonidine dosage was apparently successfully titrated in 10 out of 11 hypertensive patients already on amitriptyline or imipramine. Only clomipramine, desipramine and imipramine have been implieated so far, but other tricyclics would be expected to behave similarly (amitriptyline, nortriptyline and protriptyline have been shown to interact in animals ). The tetracyclic antidepressants maprotiline and mianserin do not generally appear to interact with clonidine. The isolated case of hypotension with trazodone is of unknown general importance. 

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