Department of Medicine, Caritas Saint Elizabeth's Medical Center, Tufts University School of Medicine Boston, Massachusetts 02135, USA.
Clin Ther. 2009 Dec;31(12):2894-9. doi: 10.1016/j.clinthera.2009.12.008.
Drug-induced fever is a clinical diagnosis and should always be considered when the fever is constant and high without a clear source of infection. Although drug-induced fever has been reported with other centrally acting antihypertensive drugs such as methyldopa, published reports of this adverse effect with clonidine in humans were not identified in a search of the literature.
A 66-year-old institutionalized white female with a history of morbid obesity (body mass index, 40 kg/m2), Alzheimer's dementia, hypertension, and depression presented to a hospital in Boston, Massachusetts (Caritas Saint Elizabeth's Medical Center) with generalized weakness and shortness of breath and was found to have a non-ST segment elevation myocardial infarction. Before hospitalization, the patient was taking memantine 10 mg PO BID, donepezil 10 mg PO once daily, duloxetine 60 mg PO once daily, clonidine 0.1 mg PO TID, metoprolol 50 mg PO BID, and amlodipine 10 mg PO once daily. On admission, the patient was initiated on aspirin 325 mg, atorvastatin 80 mg, and clopidogrel 75 mg PO daily. Her dose of clonidine was increased to 0.2 mg PO TID to optimize blood pressure control, and metoprolol and amlodipine were continued at the same doses. The patient developed fever on the third day after the cardiac catheterization. The fever ranged from 99.0 degrees F to 102.7 degrees F. The physical examination, laboratory data analysis, multiple blood cultures, urinalysis, chest radiograph, and a computed tomography of the head, chest, abdomen, and pelvis did not reveal any source of infection. On the sixth day after admission, clonidine was reduced to the baseline dose of 0.1 mg PO TID and on the ninth day it was stopped. The patient was afebrile on the twelfth day and remained so for the duration of her hospitalization. Naranjo scores for her newly initiated concomitant medications were as follows: aspirin, 1; atorvastatin, 3; clonidine, 6; and clopidogrel, 1. The rating of 6 for clonidine suggests that it was probably associated with the fever in this patient.
We describe a case of drug-induced fever probably associated with clonidine administration. The higher dose of clonidine alone or in interaction with duloxetine and atorvastatin may have contributed to the development of drug-induced fever.
药物引起的发热是一种临床诊断，当发热持续且高热而无明确感染源时，应始终考虑到这一点。虽然已有报道称其他中枢作用的降压药（如甲基多巴）会引起药物性发热，但在文献检索中未发现可乐定在人类中引起这种不良反应的报道。
一位 66 岁的白人女性，有病态肥胖（体重指数 40kg/m2）、阿尔茨海默病、高血压和抑郁症病史，因全身乏力和呼吸急促入住马萨诸塞州波士顿的一家医院（慈善圣伊丽莎白医疗中心），并被诊断为非 ST 段抬高型心肌梗死。住院前，患者服用盐酸美金刚 10mg，每日 2 次；盐酸多奈哌齐 10mg，每日 1 次；度洛西汀 60mg，每日 1 次；可乐定 0.1mg，每日 3 次；酒石酸美托洛尔 50mg，每日 2 次；以及氨氯地平 10mg，每日 1 次。入院时，患者开始服用阿司匹林 325mg、阿托伐他汀 80mg 和氯吡格雷 75mg，每日 1 次。为优化血压控制，将可乐定剂量增加至 0.2mg，每日 3 次，同时继续服用酒石酸美托洛尔和氨氯地平。患者在心脏导管术后第 3 天开始发热，体温在 99.0 至 102.7 华氏度之间。体格检查、实验室数据分析、多次血培养、尿液分析、胸部 X 线检查以及头、胸、腹和骨盆的计算机断层扫描均未发现感染源。入院第 6 天，将可乐定剂量减少至基线剂量 0.1mg，每日 3 次，第 9 天停药。入院第 12 天，患者体温正常，且在整个住院期间保持正常。患者新启用的伴随药物的 Naranjo 评分如下：阿司匹林，1 分；阿托伐他汀，3 分；可乐定，6 分；氯吡格雷，1 分。可乐定评分为 6，提示该患者的发热可能与此药有关。
我们描述了一例可能与可乐定给药有关的药物性发热病例。较高剂量的可乐定单独或与度洛西汀和阿托伐他汀联合使用可能导致了药物性发热的发生。
