Clonidine

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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

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