Clonidine

Clonidine Brand Names

Catapres | Catapres-TTS | Duraclon | JENLOGA | Kapvay | NEXICLON XR

What is Clonidine

Clonidine is a centrally acting alpha₂ agonist used transdermally for the treatment of hypertension, orally for the treatment of hypertension and attention-deficit hyperactivity disorder (ADHD), and parenterally as an epidural agent for refractory cancer pain.

It is similar to guanabenz in mechanism of action, although clonidine is less expensive.

Synthesized in the early 1960s for use as a nasal decongestant, clonidine was serendipitously found to produce hypotension, bradycardia, and sedation at remarkably low doses.

Clonidine has been used successfully for a variety of other conditions ‘off-label’, including opiate withdrawal, nicotine withdrawal, vascular headaches, diabetic diarrhea, glaucoma, ulcerative colitis, and for hot flashes.

Clonidine is used ‘off-label’ for Tourette’s syndrome, particularly when comorbid ADHD is present.

The American Academy of Neurology practice guideline states that clonidine is probably more likely than placebo to reduce tic severity in patients with Tourette’s syndrome or chronic tic disorders. For those with comorbid ADHD, clonidine may provide benefits for both conditions.

Clonidine is not considered a first-line agent for ADHD due to the potential for toxic cardiac effects and the availability of safer and more effective agents (i.e., methylphenidate, amphetamines).

When clonidine is used for the treatment of ADHD, the American Heart Association recommends careful cardiovascular screening and monitoring of patients; weigh the benefits of treatment against the risks (e.g., sedation, hypotension).

Single doses of clonidine have been used in the diagnosis of pheochromocytoma. Clonidine is effective in the treatment of severe pain in cancer patients refractory to opiate agonists.

Epidural clonidine seems to be more effective in patients with neuropathic pain rather than visceral pain.

The use of epidural clonidine has resulted in decreases in opiate requirements when used in combination with epidural opiate agonists and increases the duration of response to anesthetic agents used in peripheral nerve blocks.

Indications

1. alcohol withdrawal
2. andropause
3. attention-deficit hyperactivity disorder (ADHD)
4. autistic disorder
5. benzodiazepine withdrawal
6. cyclosporine nephrotoxicity prophylaxis
7. diabetic neuropathy
8. diarrhea
9. growth hormone deficiency diagnosis
10. hot flashes
11. hypertension
12. hypertensive emergency
13. hypertensive urgency
14. menopause
15. neonatal abstinence syndrome
16. neuropathic pain
17. opiate agonist withdrawal
18. peripheral nerve block
19. pheochromocytoma diagnosis
20. scleroderma renal crisis
21. severe pain
22. tobacco cessation
23. Tourette’s syndrome

Side Effects

1. abdominal pain
2. agitation
3. alopecia
4. angioedema
5. anorexia
6. anxiety
7. arrhythmia exacerbation
8. arthralgia
9. asthenia
10. AV block
11. blurred vision
12. bradycardia
13. chest pain (unspecified)
14. confusion
15. constipation
16. contact dermatitis
17. delirium
18. depression
19. diaphoresis
20. dizziness
21. drowsiness
22. dysgeusia
23. dyspnea
24. edema
25. elevated hepatic enzymes
26. emotional lability
27. erythema
28. fatigue
29. fever
30. fluid retention
31. GI obstruction
32. gynecomastia
33. hallucinations
34. headache
35. heart failure
36. hepatitis
37. hyperesthesia
38. hypotension
39. hypoventilation
40. ileus
41. impotence (erectile dysfunction)
42. infection
43. insomnia
44. irritability
45. lethargy
46. libido decrease
47. maculopapular rash
48. malaise
49. meningitis
50. muscle cramps
51. musculoskeletal pain
52. nasal congestion
53. nasal dryness
54. nausea
55. nightmares
56. nocturia
57. orthostatic hypotension
58. pallor
59. palpitations
60. paresthesias
61. parotitis
62. peripheral vasoconstriction
63. pruritus
64. QT prolongation
65. rash
66. restlessness
67. sinus tachycardia
68. skin hyperpigmentation
69. skin ulcer
70. stroke
71. syncope
72. throat irritation
73. thrombocytopenia
74. tremor
75. urinary incontinence
76. urinary retention
77. urticaria
78. vesicular rash
79. vomiting
80. weight gain
81. withdrawal
82. xerophthalmia
83. xerostomia

Monitoring Parameters

• blood pressure

Contraindications

• abrupt discontinuation
• anticoagulant therapy
• AV block
• bradycardia
• breast-feeding
• cardiac disease
• cerebrovascular disease
• children
• coagulopathy
• defibrillation (cardioversion)
• dehydration
• depression
• diabetes mellitus
• driving or operating machinery
• females
• geriatric
• heart failure
• hypotension
• infants
• infection
• intrathecal administration
• labor
• magnetic resonance imaging (MRI)
• myocardial infarction
• obstetric delivery
• orthostatic hypotension
• pheochromocytoma
• polyarteritis nodosa
• pregnancy
• Raynaud’s phenomenon
• renal disease
• renal failure
• renal impairment
• scleroderma
• sick sinus syndrome
• skin abrasion
• surgery
• syncope
• systemic lupus erythematosus (SLE)
• thromboangiitis obliterans (Buerger’s disease)
• vomiting

Interactions

• Acarbose
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Pseudoephedrine
• Acetazolamide
• Acrivastine; Pseudoephedrine
• Albiglutide
• Aldesleukin, IL-2
• Alemtuzumab
• Alogliptin; Metformin
• Alpha-glucosidase Inhibitors
• Alprazolam
• Alprostadil
• Amifostine
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Celecoxib
• Amoxapine
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamine; Dextroamphetamine Salts
• Amyl Nitrite
• Apomorphine
• Apraclonidine
• Aripiprazole
• Articaine; Epinephrine
• Asenapine
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Baclofen
• Benzodiazepines
• Benzonatate
• Benzphetamine
• Beta-blockers
• Bortezomib
• Bosentan
• Brexpiprazole
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Cabergoline
• Canagliflozin
• Canagliflozin; Metformin
• Cannabidiol
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Carbonic anhydrase inhibitors
• Cardiac glycosides
• Cariprazine
• Celecoxib
• Cenobamate
• Ceritinib
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroprocaine
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Clomipramine
• Clonazepam
• Clorazepate
• Clozapine
• Co-Enzyme Q10, Ubiquinone
• Cocaine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Crizotinib
• Cyclobenzaprine
• Cyclosporine
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Desipramine
• Desloratadine; Pseudoephedrine
• Deutetrabenazine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmethylphenidate
• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Diazoxide
• Diclofenac
• Diclofenac; Misoprostol
• Diethylpropion
• Diflunisal
• Digitoxin
• Digoxin
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diltiazem
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Dobutamine
• Dopamine
• Doxepin
• Dulaglutide
• Duloxetine
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enflurane
• Ephedrine
• Epinephrine
• Epoprostenol
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Esketamine
• Esomeprazole; Naproxen
• Estazolam
• Estradiol
• Estradiol Cypionate; Medroxyprogesterone
• Ethanol
• Etodolac
• Etomidate
• Exenatide
• Famotidine; Ibuprofen
• Fenoprofen
• Fexofenadine; Pseudoephedrine
• Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Flurbiprofen
• Fospropofol
• Gabapentin
• General anesthetics
• Glipizide; Metformin
• Glyburide; Metformin
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guaifenesin; Pseudoephedrine
• Haloperidol
• Halothane
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Ibuprofen
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Iloperidone
• Iloprost
• Imipramine
• Incretin Mimetics
• Indomethacin
• Insulin Degludec; Liraglutide
• Insulin Glargine; Lixisenatide
• Insulins
• Intravenous Lipid Emulsions
• Isoflurane
• Isoproterenol
• Isosorbide Dinitrate, ISDN
• Isosorbide Mononitrate
• Ketamine
• Ketoprofen
• Ketorolac
• Lansoprazole; Naproxen
• Lasmiditan
• Levocetirizine
• Levodopa
• Levomilnacipran
• Linagliptin; Metformin
• Liraglutide
• Lisdexamfetamine
• Lixisenatide
• Lofexidine
• Loratadine; Pseudoephedrine
• Lorazepam
• Lovastatin; Niacin
• Lumateperone
• Lurasidone
• Macimorelin
• Maprotiline
• Meclofenamate Sodium
• Mefenamic Acid
• Meglitinides
• Meloxicam
• Meperidine; Promethazine
• Mesoridazine
• Mestranol; Norethindrone
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methamphetamine
• Methazolamide
• Methylphenidate
• Midazolam
• Midodrine
• Miglitol
• Milnacipran
• Milrinone
• Mirtazapine
• Monoamine oxidase inhibitors
• Nabumetone
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nateglinide
• Nesiritide, BNP
• Niacin, Niacinamide
• Niacin; Simvastatin
• Nitrates
• Nitroglycerin
• Nitroprusside
• Nonsteroidal antiinflammatory drugs
• Norepinephrine
• Nortriptyline
• Olanzapine
• Opiate Agonists
• Oxaprozin
• Oxazepam
• Oxymetazoline
• Paliperidone
• Pentoxifylline
• Perphenazine
• Perphenazine; Amitriptyline
• Phendimetrazine
• Phenothiazines
• Phentermine
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Pimozide
• Piroxicam
• Pramlintide
• Prazosin
• Pregabalin
• Prilocaine; Epinephrine
• Procainamide
• Procaine
• Prochlorperazine
• Promethazine
• Propofol
• Protriptyline
• Pseudoephedrine
• Quazepam
• Quetiapine
• Quinidine
• Rasagiline
• Repaglinide
• Risperidone
• Ritodrine
• Rofecoxib
• Semaglutide
• Sevoflurane
• SGLT2 Inhibitors
• Silodosin
• Sulfonylureas
• Sulindac
• Temazepam
• Tetrabenazine
• Tetracaine
• Thiazolidinediones
• Thiethylperazine
• Thioridazine
• Thiothixene
• Tizanidine
• Tolmetin
• Trandolapril; Verapamil
• Trazodone
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trimipramine
• Valdecoxib
• Verapamil
• Yohimbine
• Ziprasidone