Can Valdoxan (Agomelatine), Rivotril (Clonazepam), and Quetiapine Cause Hair Loss?
Yes, all three medications can cause hair loss, though the evidence strength varies: clonazepam (Rivotril) has documented reports, quetiapine has confirmed case reports with causal relationship, and agomelatine (Valdoxan) has been used as a treatment for valproate-induced hair loss but lacks evidence as a causative agent.
Evidence by Medication
Clonazepam (Rivotril)
Clonazepam is documented to cause alopecia, though it occurs rarely. 1 reports that clonazepam can lead to hair loss on rare occasions among benzodiazepines. This is a recognized but uncommon adverse effect in psychopharmacology.
Quetiapine
Quetiapine definitively causes alopecia based on published case reports. 2 presents the first published cases of alopecia associated with quetiapine, including 2 cases from the New Zealand Intensive Medicines Monitoring Programme where assessment suggested a causal relationship with the medication, plus 15 additional cases from the WHO international database. The FDA label for quetiapine 333 does not list alopecia as a labeled adverse effect, but post-marketing surveillance has established this association.
The hair loss pattern with quetiapine is typically:
- Diffuse and non-scarring
- Reversible with dose adjustment or discontinuation
- Similar to telogen effluvium pattern seen with other psychotropic medications
Agomelatine (Valdoxan)
Agomelatine does not appear to cause hair loss. In fact, 4 mentions agomelatine as a potential treatment option for valproate-associated hair abnormalities, though this lacks strong evidence. There are no published reports linking agomelatine to alopecia as an adverse effect.
Clinical Management Algorithm
If hair loss develops on these medications:
- Confirm the diagnosis: Perform pull test and modified wash test to document active hair shedding
- Assess timing: Hair loss typically begins weeks to months after medication initiation
- Rule out other causes: Check thyroid function (TSH and free T4), iron studies, and nutritional status
- Management hierarchy:
- First: Consider dose reduction if clinically feasible
- Second: Switch to alternative medication if psychiatric condition allows
- Third: Reassure patient that hair loss is reversible with medication adjustment
- Fourth: Consider biotin and mineral supplementation while continuing medication if discontinuation is not possible
Important Caveats
- Discontinuation or dose reduction almost always leads to complete hair regrowth 1
- The cosmetic side effect of alopecia significantly contributes to medication non-compliance, so proactive discussion is essential
- Among psychotropic medications, mood stabilizers (particularly valproate) have the highest incidence of hair loss (up to 28%), while antipsychotics and benzodiazepines cause it less frequently 15
- Hair loss from these medications is characteristically diffuse, non-scarring, and follows a telogen effluvium pattern 5