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Fever (first report for clonidine) in an elderly patient: case report A 66-year-old woman developed fever during clonidine therapy for hypertension, duloxetine for depression, and atorvastatin [therapeutic indication not stated]. The woman, who had a history of morbid obesity, Alzheimer’s dementia, hypertension and depression, was admitted because of generalised weakness and dyspnoea. Her current medications, all taken orally, included memantine, donepezil, duloxetine 60mg once daily, clonidine 0.1mg three times daily, metoprolol and amlodipine. She was diagnosed with a myocardial infarction and underwent cardiac catheterisation to receive a coronary stent. On admission, her dosage of clonidine was increased to 0.2mg thrice daily, and she started to receive atorvastatin 80mg, aspirin and clopidogrel. On the third day after cardiac catheterisation, she developed fever that ranged from 99 to 102.7°F [duration of clonidine and duloxetine treatment to reaction onset not stated]. Her fever was high and constant, but she remained haemodynamically stable. She had a WBC count of 7200/µL with 70% polymorphonuclear cells. Other investigations, including multiple blood cultures, were unremarkable, and no source of infection was identified. She was given a diagnosis of a possible drug-induced fever. Atorvastatin was stopped on the fourth day after cardiac catheterisation because of an elevated creatine phosphokinase level. The woman’s dosage of clonidine was reduced to 0.1mg thrice daily on the sixth, and was discontinued on the ninth hospital day. Her fever resolved on day 12 and she remained afebrile for the rest of her hospital stay. She was discharged after 2 weeks of hospitalisation. Author comment: "Application of the Naranjo adverse drug reaction probability scale to this case (score of 6 for clonidine) suggested that the fever was probably associated with the higher dose of clonidine. . . The higher dose of clonidine alone or in interaction with duloxetine and atorvastatin may have contributed to the development of drug-induced fever." Kelesidis T, et al. Unexplained high fever in an elderly patient treated with clonidine, duloxetine, and atorvastatin. Clinical Therapeutics 31: 2894-2899, No. 12, Dec 2009. Available from: URL: http://dx.doi.org/10.1016/ 803009332 j.clinthera.2009.12.008 - USA

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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any case reports of fever associated with clonidine. The WHO ADR database contained 43 reports of pyrexia associated with clonidine.

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Reactions 3 Apr 2010 No. 1295