US EPA

2250264 

Journal Article 

Hypertensive urgency induced by an interaction of mirtazapine and clonidine 

Abo-Zena, RA; Bobek, MB; Dweik, RA 

2000 

1 

Pharmacotherapy
ISSN: 0277-0008
EISSN: 1875-9114 

IPA/00/1200111 

VOL 20 ISS 4 2000 

REF 7 

476-478 

eng 

IPA COPYRIGHT: ASHP The case of a 20-yr-old man with hypertension whose blood pressure had been controlled with metoprolol, losartan, and clonidine and who was treated for hypertensive urgency 2 wk after starting mirtazapine for the treatment of depression is presented. After starting mirtazapine, the patient's blood pressure rose, and the dosage of losartan was increased. Since improved blood pressure control was not achieved, losartan was stopped and minoxidil was started. The patient's regimen at the time of presentation to the emergency department with hypertensive urgency included 0.1 mg of clonidine twice daily, 100 mg of metoprolol twice daily, 2.5 mg of minoxidil twice daily, and 15 mg of mirtazapine daily. He received treatment with intravenous injections of nitroglycerin, labetalol, and nitroprusside and emergency dialysis. On hospital day 2, it was discovered that the patient had been prescribed mirtazapine just 2 wk earlier. Because of a potential drug interaction between clonidine and mirtazapine, the latter agent was discontinued. Discharge therapy with controlled blood pressure consisted of 5 mg of minoxidil twice daily, 0.1 mg of clonidine twice daily, and 100 mg of metoprolol twice daily. The patient did not have any subsequent episodes of hypertensive urgency.