Risks of clonidine (Catapresan) use in pregnancy.

Fråga: Risks of clonidine (Catapresan) use in pregnancy.

Sammanfattning: Teratogenicity has not been reported in the limited published experience on clonidine use

in pregnancy. However, there were no cases of first trimester clonidine exposure.

Svar: Clonidine has been used during pregnancy to treat hypertension (either associated with

pregnancy or essential hypertension) (1). It has also recently been proposed as an alternative

therapy for drug abuse withdrawal symptoms (2), including the investigational treatment of

neonatal narcotic withdrawal syndrome (3).

As reviewed in Schardein´s Chemically induced birth defects (4), no teratogenic effects were

observed with tests in the rat, rabbit and mouse. In humans, published experience on

clonidine use in pregnancy is very limited. The number of patients receiving clonidine for

treatment of hypertension in several reports (5-8) amounts to 67 women at various stages of

pregnancy (from 23 weeks gestation to labour). In these publications no adverse fetal effects

were reported.

Huisjes et al (9) studied 22 children prenatally exposed to clonidine and no other hypotensive

drugs at a mean age of 6.3 plus minus 1.6 years, compared to a non-exposed control group

matched for degree of maternal hypertension, sex, birthweight, and gestational age. No

differences were observed in head circumference, neurological findings, school performance

and a number of behavioural characteristics except for a marginal excess of hyperactivity and

an excess of sleep disturbances in the studied group. The significance of this finding is

uncertain. 1 Martindale, The extra pharmacopoeia, 1982; 28th ed: 139-142
2 Avery´s Drug treatment, 1987; 3rd ed: 1196
3 Hoder EL, Leckman JF, Poulsen J, Caruso KA, Ehrenkranz RA, Kleber HD, Cohen DJ:
Clonidine treatment of neonatal narcotic abstinence syndrome. Psychiatry Res 1984; 13:
243-251
4 Schardein, Chemically induced birth defects. 1985, p 69
5 Johnston CI, Aickin DR: The control of high blood pressure during labour with clonidine
("Catapres"). Med J Aust 1971; 2: 132-135
6 Leighton PW, Tighe H: A critical survey of drugs used in the treatment of hypertensive
crises of pregnancy. Med J Aust 1974; 2: 680-682
7 Horvarth JS, Phippard A, Korda A, Henderson-Smart DJ, Child A, Tiller DJ: Clonidine
hydrochloride - a safe and effective antihypertensive agent in pregnancy. Obstet Gynecol
1985; 66: 634-638
8 Hartikainen-Sorri AL, Heikkinen JE, Koivisto M: Pharmacokinetics of clonidine during
pregnancy and nursing. Obstet Gynecol 1987; 69: 598-600
9 Huisjes HJ, Hadders-Algra M, Touwen BC: Is clonidine a behavioural teratogen in the

human? Early Hum Dev 1986; 14: 43-48