Clonidine

Brands

DEA Class;  Rx

Common Brand Names; Catapres, Catapres-TTS, Duraclon, Jenloga, Kapvay, Nexiclon XR

  • Alpha2 Agonists, Central-Acting; 
  • ADHD Agents

Centrally-acting alpha2-agonist
Oral and transdermal drug for HTN and autonomic hyperactivity (e.g., drug withdrawal syndromes); also used orally for ADHD
Epidural product is used for refractory pain

Indicated for the treatment of hypertension.

For the treatment of attention-deficit hyperactivity disorder (ADHD) in pediatric patients as monotherapy or as adjunctive therapy to a psychostimulant.

For the treatment of severe pain.
For the treatment of hypertensive urgency or hypertensive emergency.
For the treatment of opiate agonist withdrawal and/or benzodiazepine withdrawal.
For the treatment of neonatal abstinence syndrome.
For the symptomatic treatment of diabetic neuropathy.
For the treatment of diabetic diarrhea.
For use as an adjunct to psychosocial interventions in the management of tobacco cessation (smoking cessation).
For the treatment of hypertension and the subsequent decline in renal function associated with scleroderma renal crisis (SRC).
For minimization of nephrotoxicity in patients receiving cyclosporine (i.e., cyclosporine nephrotoxicity prophylaxis) and low-dose methotrexate for allogeneic bone marrow transplant.
 

Hypersensitivity

Epidural

  • Concurrent anticoagulants, bleeding diathesis
  • Presence of injection site infections
  • Administration above C4 dermatome, due to lack of adequate safety data
  • Obstetric/perioperative pain
  • Skin reactions; patch (15-50%)
  • Dry mouth (40%)
  • Somnolence (19-38%)
  • Headache (19-29%)
  • Fatigue (13-24%)
  • Drowsiness (33%)
  • Dizziness (13-16%)
  • Hypotension, epidural (45%)
  • Postural hypotension, epidural (32%)
  • Anxiety (11%)
  • Constipation (10%)
  • Sedation (10%)
  • Nausea/vomiting, PO (5%)
  • Malaise (3%)
  • Orthostatic hypotension (3%)
  • Anorexia, PO (1%)
  • Abnormal LFTs (1%)
  • Rash (1%)
  • Weight gain, PO (1%)

Epidural: Hemodynamically unstable patients (risk of severe hypotension)

Do not discontinue suddenly (risk of rebound hypertension)

Patch: May need to remove if severe erythema and/or localized vesicle formation develop at application site or generalized rash; consult physician

Severe coronary insufficiency

May cause xerostomia

Recent MI

Cerebrovascular disease

Chronic renal failure

Raynaud’s disease

Thromboangiitis obliterans

History of depression (may exacerbate depression in cancer patients)

May impair ability to perform hazardous tasks

Remove patch before MRI (may cause burns)

Hypotension may occur; usually responsive to IV fluids and, if necessary, appropriate parenterally administered pressor agents

There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, during pregnancy

Based on published lactation studies, clonidine hydrochloride is present in human milk at relative infant doses ranging from 4.1 to 8.4% of maternal weight-adjusted dosage

Adults

Hypertension

Immediate-release tablets

  • 0.1 mg PO q12hr

  • Range: 0.1-0.2 mg/day q12hr; not to exceed 2.4 mg/day

Transdermal

  • Apply 1 patch q7Days; start with 0.1 mg; increase by 0.1 mg after q1-2Week interval; usual dose range is 0.1-0.3 mg qWeek

Cancer Pain

Epidural infusion

  • Severe pain in patients with cancer not adequately relieved by opioid analgesics alone

  • Initial: 30 mcg/hr

  • Titrate as required for pain relief or presence of side effects

  • Limited data on doses exceeding 40 mcg/hr

Acute Hypertension (Off-label)

0.1-0.2 mg PO; may follow with additional doses of 0.1 mg qhr PRN to maximum 0.6 mg total dose

EtOH Withdrawal (Off-label)

0.3-0.6 mg PO q6hr

Smoking Cessation (Off-label)

PO administration: 0.1 mg qDay; increase by 0.1 mg/day to 0.15-0.75 mg/day if required

TD administration: 100-200 mcg/day patch q7Days

Restless Legs Syndrome (Off-label)

100-300 mcg PO 2 hours befor bedtime, up to 900 mcg/day

Tourette’s Syndrome (Off-label)

0.0025-0.015 mg/kg/day PO for 6 weeks to 3 months

Cyclosporine Nephrotoxicity (Off-label)

100-200 mcg/day transdermal patch; change q7Days

Menopausal Flushing (Off-label)

Apply 100 mcg/day patch; change q7Days, OR

50 mcg PO q12hr initially; may increase up to 400 mcg q12hr

Dysmenorrhea (Off-label)

PO administration: 0.025 mg q12hr for 2 weeks prior to menstruation

Opioid Withdrawal (Off-label)

PO administration: 0.1-0.3 mg q4-6hr; increase by 0.1 mg/day to 0.15-0.75 mg/day if required; do not exceed 2.4 mg/day

TD administration: 100-200 mcg/day patch q7Days; initiate 0.1-0.3 mg PO q4-6hr for first 2 days to allow for adequate drug levels

Postherpetic Neuralgia (Off-label)

PO administration: 0.1 mg q12hr

Psychosis (Off-label)

PO administration: 0.4-1.4 mg/day in divided doses

Pheochromocytoma Diagnosis (Off-label)

Clonidine suppression testing: 0.3 mg PO for 60-80 kg patient; obtain blood sample 3 hours after administration to supine patient

Pediatric

Hypertension

>12 years old

  • Immediate-release tablets: 0.2 mg/day PO divided q12hr; increase qWeek; maintenance dose range, 0.2-0.6 mg/day q12hr; not to exceed 2.4 mg/day
  • Transdermal patch: 0.1 mg patch q7Day initially; may increase by weekly 0.1-mg increments after 1-2 weeks if desired blood pressure reduction not achieved; not to exceed 0.6 mg/week (ie, 2 clonidine 0.3 mg patches)

<12 years old

  • Immediate-release tablets and transdermal patch: Safety and efficacy not established

ADHD

<6 years old: Not established

≥6 years old (extended-release tablets, Kapvay): 0.1 mg PO qHS initially; may adjust dose by increments of 0.1 mg/day at weekly intervals until desired response; not to exceed 0.4 mg/day

Clonidine hydrochloride

injectable solution

  • 100mcg/mL
  • 500mcg/mL

patch, extended-release

  • 0.1mg/day
  • 0.2mg/day
  • 0.3mg/day

tablet, immediate-release

  • 0.1mg
  • 0.2mg
  • 0.3mg

tablet, extended-release

  • 0.1mg
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