Bottom line: Diuretics most often cause neuropsychiatrie symptoms indirectly, through electrolyte abnormalities (thiazides) or vitamin deficiencies (loop diuretics). Acetazolamide is associated with fatigue and with delirium in renal failure. Small studies suggest that acetazolamide may provide benefits in sleep apnea or bipolar disorder. Centrally acting agents Clonidine Clonidine, a central α-adrenergic agonist, is associated with a number of neuropsychiatrie effects. Fatigue and sedation are the most common effects, with sedation occurring in one third

or more of patients.121-123 Mood disturbance has been infrequently Inhibitors,research,lifescience,medical described with clonidine; pooled information suggests that depression occurs in approximately 1% to 2% of patients taking clonidine, and there

are no case reports of clonidine-induced depression or mania, R428 in vivo though there has been one report of hypomania in a patient with Inhibitors,research,lifescience,medical pre-existing depression.121,122 Hallucinations can occur with clonidine, though rarely; one case report describes a man with two episodes of hallucinations associated with clonidine that resolved with discontinuation in both instances.124 Finally, clonidine may Inhibitors,research,lifescience,medical also affect cognition in certain patients. It has been associated with cognitive slowing,123,125 and there have been at least seven case reports of delirium associated with the use of clonidine.126 However, the neuropsychiatrie consequences of clonidine are most often Inhibitors,research,lifescience,medical those associated with its therapeutic uses. Clonidine has been used to treat a variety of neuropsychiatrie illnesses. Clonidine is frequently used (as secondline monotherapy or as an adjunctive agent) to treat attention deficit-hyper activity disorder Inhibitors,research,lifescience,medical (ADHD), particularly among patients with comorbid tics or prominent hyperactivity, impulsivity, or aggression.127-129 Clonidine is generally less effective than are psychostimulants

in the treatment of ADHD, but a recent meta-analysis found that clonidine is moderately efficacious as monotherapy for symptoms of ADHD.127 Another large study found that clonidine was efficacious both as monotherapy and as an adjunctive nearly agent for patients with ADHD and comorbid tics.128 In addition, clonidine is frequently used to reduce symptoms of opiate withdrawal; clonidine decreases norepinephrine release during opiate withdrawal by binding presynaptically to the α2 receptors.47 A comprehensive review130 of clonidine use for opiate withdrawal found that withdrawal symptoms were generally reduced similarly by clonidine and by a tapering schedule of long-acting opiates (eg, methadone). Rates of completion of withdrawal protocols were similar with use of clonidine and an opiate taper. However, subjects had more side effects with clonidine and stayed in treatment longer when opiates were used.