title: Clonidine and dexmedetomidine produce antinociceptive synergy in mouse spinal cord.
abstract: BACKGROUND
  Synergy between drugs manifests with increased potency and/or efficacy of the combination relative to either agonist given alone. Synergy is typically observed between drugs of different classes, as is the case with the alpha-adrenergic-opioid receptor synergy often observed in preclinical studies. However, rare studies report synergy between agonists of the same class. The current study examined the analgesic interaction between two intrathecally injected alpha2-adrenergic receptor (AR) agonists previously thought to act at the same receptor subtype when given spinally.
  
  
  METHODS
  Mice were given clonidine, dexmedetomidine, or the combination spinally to evaluate the interaction between these two agonists. The ED50 values were calculated, and the interactions were tested by isobolographic analysis. The rotarod test was performed in the same mice after the completion of analgesic assessment to assess motor or sedative effects. These experiments were performed in outbred mice as well as in mice with mutant alpha2A ARs, alpha2C AR knockout mice, or wild-type controls. Finally, analgesic cross-tolerance between clonidine and dexmedetomidine was evaluated.
  
  
  RESULTS
  Clonidine and dexmedetomidine interacted synergistically in all lines except the alpha2C AR knockout line, implicating alpha2C ARs in the interaction. In addition, clonidine and dexmedetomidine did not show analgesic cross-tolerance in the outbred strain, suggesting that the two drugs have distinct mechanisms of action.
  
  
  CONCLUSIONS
  The current study introduces a new synergistic agonist pair, clonidine-dexmedetomidine. These two drugs seem to require the alpha2A AR for spinal analgesia when given separately; when delivered as a combination, the resultant synergistic interaction requires the alpha2C AR as well.
authors.affiliation: Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota 55455-0217, USA. carfair@umn.edu
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Fairbanks
authors.forename: Kelley F
authors.initials: KF
authors.lastname: Kitto
authors.forename: H Oanh
authors.initials: HO
authors.lastname: Nguyen
authors.forename: Laura S
authors.initials: LS
authors.lastname: Stone
authors.forename: George L
authors.initials: GL
authors.lastname: Wilcox
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D000818:Animals; D003000:Clonidine / Q000008:administration & dosage*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D018345:Mice, Knockout; D010147:Pain Measurement / Q000187:drug effects*; D013116:Spinal Cord / Q000187:drug effects* / Q000502:physiology
chemical_list: D000700:Analgesics; D020927:Dexmedetomidine; D003000:Clonidine