Neuroleptics clonidine

Other drugs that are reported to have beneficial effects but which have not undergone such extensive evaluation as the neuroleptics or carbamazepine include the calcium channel antagonists such as verapamil. A small open study has suggested that the alpha2 adrenoceptor agonist clonidine may... 

Beta-blockers interact with a large number of other medications. The combination of beta-blockers with calcium antagonists should be avoided, given the risk for hypotension and cardiac arrhythmias. Cimetidine, hydralazine, and alcohol all increase blood levels of beta-blockers, whereas rifampicin decreases their concentrations. Beta-blockers may increase blood levels of phenothiazines and other neuroleptics, clonidine, phen-ytoin, anesthetics, lidocaine, epinephrine, monoamine oxidase inhibitors and other antidepressants, benzodiazepines, and thyroxine. Beta-blockers decrease the effects of insulin and oral hypoglycemic agents. Smoking, oral contraceptives, carbamazepine, and nonsteroidal anti-inflammatory analgesics decrease the effects of beta-blockers (Coffey, 1990). 

Clonidine has also been useful in one controlled study and in a few case reports. Although this agent has the advantage of avoiding acute and chronic EPS associated with neuroleptics, its effects on blood pressure have appropriately constrained its use in this age population. There is also the concern regarding rebound hypertension if this agent is abruptly discontinued (e.g., noncompliance). 

Neuroleptics are the drugs of choice in the treatment of tic disorders but they should only be considered in situations where the life of the child is seriously affected and when behavioural treatments have failed. Of the classical neuroleptics which have been used, haloperidol and pimozide have shown success but so far there have been no adequately controlled trials of any neuroleptic to objectively validate their efficacy. It would appear that only low doses of haloperidol are necessary (2-3mg/day) to obtain a significant reduction in tic frequency. It would seem reasonable to consider the use of the atypical antipsychotics for these disorders but, to date, there is no evidence of their efficacy in children. Recently there have been studies in which clonidine was used in the effective treatment of motor tics. The side effects are similar to those seen in the adult and include sedation, headache, irritability and sinus bradycardia. 

Hypersalivation or sialorrhea has been reported with all neuroleptic drugs, and has been associated with risperidone as one of the most frequently mentioned adverse effects in patients with disturbing extrapyramidal symptoms during previous neuroleptic drug treatment (SEDA-25, 68). Hypersalivation is a troublesome adverse effect that can contribute to non-adherence to therapy, but it can be treated with clonidine. 

Although phenothiazines, clonidine, carbamazepine, y-hydroxybutyric acid, and valproic acid may reduce symptoms of alcohol withdrawal, their ability to prevent seizures or delirium tremens has yet to be proven, and in fact, the phenothiazines may lower the seizure threshold. Other drugs used to treat symptoms of alcohol withdrawal include other barbiturates, alcohol itself, sympatholytics such as atenolol, thiamine, magnesium, and other neuroleptics such as haloperidol. At the time of this writing, gabapentin is being compared to lorazepam for acute alcohol withdrawal in a phase II clinical trial. 

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