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Clonidine: Sudden Deaths
There have been four sudden deaths reported in children taking clonidine and methylphenidate together (Swanson et al. 1995; Cantwell et al. 1997; Fenichel 1995). Review of the case details demonstrated
other causes of death, including an anomalous coronary artery, postnatal cardiac damage, and a grand mal seizure (Wilens et al. 1999; Hagerman 1996; Dech 1999). However, these reports led to the recommendation of cardiac monitoring
with an EKG when clonidine or guanfacine is used, particularly in patients with FXS, because rare cases of sudden death have been reported even when no medication has been used (chap. 1). Clonidine can prolong conduction through
the atrioventricular (AV) node, and rare dysarrhythmias have been reported (Dawson et al. 1989; Chandran 1994). The use of clonidine both with and without a stimulant has grown considerably over the last decade, and Wilens et al.
(1999) reported that more than 1,200 children have received clonidine and methylphenidate in their two clinics without adverse cardiovascular events. We have also had no cardiac problems in using clonidine and methylphenidate
together in more than 50 children with FXS, except for two young children who ate their clonidine patch and were hospitalized (Amaria et al. 2001; Delahunty et al., unpublished manuscript). Kofoed et al. (1999) followed the EKG in
42 children treated with clonidine for ADHD and/or tic disorder, and 30 were also on stimulants. Significant EKG abnormalities were not seen either with clonidine alone or when combined with stimulants.
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This article is not intended to give medical advice for individual cases. Any change in medical treatment
should be done in consultation with appropriate medical personnel. This article is written for medical professionals. Some of the terms will be unfamiliar to those who are not trained in medical fields.
*This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited
by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002. It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in
the book which are not included as part of this website.
The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling
1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.
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Medical Follow-up Pharmacotherapy Future Prospects
Outline Medications Medical Conditions
References: A, B, C, D, EF, G, H, IJ, K, L, M, NOP, QR, S, T, UVWXYZ
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