HWN Suggests

Should we throw away the clonidine?

In regards to clonidine, many outpatient offices and urgent cares continue to implement this treatment for hypertension in the office. Yes, this will give you a “nice number” to document that makes you and the patient feel comfortable to discharge them home but it is likely doing more harm than good. There are not validated controlled studies that support any promising long term outcomes with acute treatment. These patients likely did not become hypertensive overnight so fixing them quickly with fast acting agents can lead to hypotension and drop the blood pressure below the autoregulatory zone which can lead to decreased perfusion to the brain.

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Articles of Interest

A Toxic Slumber

Clonidine toxicity mimics opioid toxicity — it causes miosis, respiratory depression and decreased level of consciousness. However, bradycardia and hypotension are more prominent.

Clonidine in the acute patient

When using clonidine for acute withdrawal or blood pressure control, oral tablets are the preferred route. Clonidine transdermal patches have slow absorption and take 2-3 days for the effect to be seen. Once removed, clonidine patches can provide therapeutic levels for up to 20 hours. Bottom Line: If clonidine is needed acutely for your patient, select oral tablets and titrate to effect.

Clonidine toxicity

Clonidine has a vast array of uses including anxiety, ADHD, hypertension, withdrawal (opitates, alcohol and smoking), migraines, menopausal flushing, diarrhoea and finally pain. It causes the classic triad of drowsiness, miosis and bradycardia in overdose.

Drugs Five Years Later

Clonidine represents the prototype of a new class of centrally acting antihypertensive agents, classed as partial alpha-adrenergic antagonists. Blood pressure reduction is characterized, hemodynamically, by reduced cardiac output with unchanged peripheral vascular resistance at rest. Reflex control of blood pressure during orthostasis and exercise appears to be unimpaired, and orthostatic hypotension is uncommon.

Everything You Need to Know About Clonidine

With its use in medicine for more than 40 years, clonidine is a type of drug that effectively treats hypertension and mental disorders but may also treat symptoms of menopause. Drug manufacturers often deliver the medicine in immediate-release tablets, extended-release tablets, solutions, or patches.

Exploring The Worst Side Effects Of Catapres

In addition to its use in managing high blood pressure, Catapres has other important roles in medicine.

Spotlight on clonidine

Clonidine stimulates alpha-2 adrenoreceptors in the brain stem. This results in reduced sympathetic outflow from the central nervous system and decreases in peripheral resistance, renal vascular resistance, heart rate and blood pressure.

Treating Hypertension in the Emergency Department: First, Do No Harm, Part II

Clonidine (Catapres) is a useful drug for emergency medicine because it has a short onset of action, lowers blood pressure predictably, and generally is well-tolerated. However, chronic clonidine users who abruptly discontinue its use can develop significant rebound hypertension. Its side effects include postural hypotension, reflex tachycardia, first dose syncope, dizziness, weakness, fatigue, and headache.

Resources

Clonidine (Catapres)

0.1 mg tablet twice daily (morning and bedtime). Elderly patients may benefit from a lower initial dose.

OzEMedicine

Centrally acting alpha 2 adrenergic agonist. Appears to reduce neurally mediated plasma catecholamine levels. Primarily used as an antihypertensive but has also been used to Rx:

StatPearls

Clonidine has multiple off-label uses, such as managing withdrawal symptoms from opioids, benzodiazepines, and alcohol and treating anxiety, insomnia, and post-traumatic stress disorder (PTSD).[5] Because of the effect of clonidine on the sympathetic nervous system, specifically, the reduction of circulating epinephrine, it has been used in many other aspects of medicine, for example, control of hot flashes in menopause, restless leg syndrome, and prophylaxis of vascular migraine headaches.