CLONIDINE HYDROCHLORIDE

(kloe'ni-deen)
Catapres, Catapres-TTS, Dixaril , Duraclon
Classifications: CARDIOVASCULAR AGENT; CENTRAL-ACTING ANTIHYPERTENSIVE;
ANALGESIC
Prototype: Methyldopa
Pregnancy Category: C

Availability
0.1 mg, 0.2 mg, 0.3 mg tablets; 0.1 mg/24 h, 0.2 mg/24 h; 0.3 mg/24 h transdermal patch;
100 mcg/mL, 500 mcg/mL injection

Actions
Centrally acting antiadrenergic derivative. Stimulates alpha2-adrenergic receptors in CNS
to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of
norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects
tend to be mild and occur infrequently. Also inhibits renin release from kidneys.

Therapeutic Effects
Decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and
occur infrequently. Reportedly minimizes or eliminates many of the common clinical
S&S associated with withdrawal of heroin, methadone, or other opiates.

Uses
Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with
diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for
severe pain.

Unlabeled Uses
Prophylaxis for migraine; treatment of dysmenorrhea, menopausal flushing, diarrhea,
paroxysmal localized hyperhidroses; alcohol, smoking, opiate, and benzodiazepine
withdrawal; in the clonidine suppression test for diagnosis of pheochromocytoma; Gilles
de la Tourette syndrome; attention deficit disorder with hyperactivity (ADDH) in
children.

Contraindications
Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa,
scleroderma, SLE.
Cautious Use
Severe coronary insufficiency, recent MI, sinus node dysfunction, cerebrovascular
disease; chronic renal failure; Raynaud's disease, thromboangiitis obliterans; history of
mental depression.

Route & Dosage

Hypertension
Adult: PO 0.1 mg b.i.d. or t.i.d., may increase by 0.1–0.2 mg/d until desired response is
achieved (max: 2.4 mg/d) Transdermal 0.1 mg patch once q7d, may increase by 0.1 mg
q1–2 wk
Geriatric: PO Start with 0.1 mg once daily
Child: PO 5–10 mcg/kg/d divided q8–12h, may increase to 5–25 mcg/kg/d divided q6h
(max: 0.9 mg/d)

Severe Pain
Adult: Epidural start infusion at 30 mcg/h and titrate to response. Use rates >40 mcg/h
with caution
Child: Epidural start infusion at 0.5 mcg/kg/h and titrate to response

ADDH
Child: PO 5 mcg/kg/d in 4 divided doses (average dose, 0.15–0.2 mg/d) Transdermal 0.2–
0.3 mg/d q5–7d

Administration
• Give last PO dose immediately before patient retires to ensure overnight BP
control and to minimize daytime drowsiness.
• Oral dosage is increased gradually over a period of weeks so as not to lower BP
abruptly (especially important in the older adult). Follow-up visits should be
scheduled every 2–4 wk until BP stabilizes, then every 2–4 mo.
• Apply transdermal patch to dry skin, free of hair and rash. Avoid irritated,
abraded, or scarred skin. Recommended areas for applying transdermal patch are
upper outer arm and anterior chest. Less drug is absorbed from thighs. Rotate
application sites and keep a record.
• During change from PO clonidine to transdermal system, PO clonidine should be
maintained for at least 24 h after patch is applied. Consult physician.
• Do not abruptly discontinue drug. It should be withdrawn over a period of 2–4 d.
Abrupt withdrawal resembles sympathetic stimulation and may result in
restlessness and headache 2–3 h after a missed dose and a hypertensive crisis
within 8–18 h.
• Store in tightly closed container at 15°–30° C (59°–86° F) unless otherwise
directed.
Adverse Effects ( 1%)
CV: Hypotension (epidural), postural hypotension (mild), peripheral edema, ECG
changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt withdrawal.
GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction of large bowel, altered
taste, nausea, vomiting, hepatitis, hyperbilirubinemia, weight gain (sodium retention).
CNS: Drowsiness, sedation, dizziness, headache, fatigue, weakness, sluggishness,
dyspnea, vivid dreams, nightmares, insomnia, behavior changes, agitation, hallucination,
nervousness, restlessness, anxiety, mental depression. Skin: Rash, pruritus, thinning of
hair, exacerbation of psoriasis; with transdermal patch: hyperpigmentation, recurrent
herpes simplex, skin irritation, contact dermatitis, mild erythema. Special Senses: Dry
eyes. Urogenital: Impotence, loss of libido.

Diagnostic Test Interference

Possibility of decreased urinary excretion of aldosterone, catecholamines, and VMA
(however, sudden withdrawal of clonidine may cause increases in these values); transient
increases in blood glucose; weakly positive direct antiglobulin (Coombs') tests.

Interactions
Drug: Alcohol and other CNS DEPRESSANTS add to CNS depression; TRICYCLIC
ANTIDEPRESSANTS may reduce antihypertensive effects. OPIATE ANALGESICS increase
hypotension with epidural clonidine. Increased risk of bradycardia or AV block when
epidural clonidine is used with digoxin, CALCIUM CHANNEL BLOCKERS, or BETA-
BLOCKERS.

Pharmacokinetics
Absorption: Readily absorbed from GI tract. Onset: 30–60 min PO; 1–3 d transdermal.
Peak: 2–4 h PO; 2–3 d transdermal. Duration: 8 h PO; 7 d transdermal. Distribution:
Widely distributed; crosses blood–brain barrier; not known if crosses placenta or
distributed into breast milk. Metabolism: Metabolized in liver. Elimination: 80%
excreted in urine, 20% in feces. Half-Life: 6–20 h.

NURSING IMPLICATIONS
Assessment & Drug Effects

• Monitor BR closely. Determine positional changes (supine, sitting, standing).

• With epidural administration, frequently monitor BP and HR. Hypotension is a
common side effect that may require intervention.
• Monitor BP closely whenever a drug is added to or withdrawn from therapeutic
regimen.
 • Monitor I&O during period of dosage adjustment. Report change in I&O ratio or
change in voiding pattern.
• Determine weight daily. Patients not receiving a concomitant diuretic agent may
gain weight, particularly during first 3 or 4 d of therapy, because of marked
sodium and water retention.
• Supervise closely patients with history of mental depression, as they may be
subject to further depressive episodes.

Patient & Family Education

• Although postural hypotension occurs infrequently, make position changes

slowly, and in stages, particularly from recumbent to upright position, and dangle
and move legs a few minutes before standing. Lie down immediately if faintness
or dizziness occurs.
• Avoid potentially hazardous activities until reaction to drug has been determined
due to possible sedative effects.
• Do not omit doses or stop the drug without consulting the physician.
• Do not take OTC medications, alcohol, or other CNS depressants without prior
discussion with physician.
• Examine site when transdermal patch is removed and report to physician if
erythema, rash, irritation, or hyperpigmentation occurs.
• If transdermal patch loosens, tape it in place with adhesive. The patch should
never be cut or trimmed.
• Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined: generic names in bold; classifications
in SMALL CAPS; Canadian drug name; Prototype drug

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