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clonidine

clonidine (Catapres)

see also:

Introduction

  • 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:
    • has been used to prevent migraine attacks in 75-150mcg daily doses but less effective than other preventives, although it appears to have 30-50% of patients who have a 50% or more reduction in headache frequency
    • post-operative agitation and pain
    • opiate withdrawal
    • benzodiazepine withdrawal
    • alcohol withdrawal
    • nicotine withdrawal
    • Tourette syndrome
    • hot flushes of menopause
    • hyperarousal caused by post-traumatic stress disorder, borderline personality disorder, and other anxiety disorders
    • has been successfully used topically in a clinical trial as a treatment for diabetic neuropathy
    • has been used to treat diarrhoea associated with irritable bowel syndrome, fecal incontinence, diabetes, withdrawal-associated diarrhea, intestinal failure, neuroendocrine tumors and cholera

C/I

  • Severe bradyarrhythmia due to sick sinus syndrome
  • 2nd or 3rd degree A-V block
  • oral tablet form: hereditary galactose intolerance eg galactosaemia

Precautions

  • abrupt withdrawal (esp with prolonged use, high dose) may cause restlessness, palpitations, rapid rise in blood pressure, nervousness, tremor, headache or nausea. Wean over 7 days if possible.
  • depression history;
  • advanced cerebrovascular disease
  • hepatic, renal impairment
  • diabetes
  • mild-mod bradyarrhythmia
  • perfusion disorder
  • polyneuropathy
  • constipation
  • congestive cardiac failure or severe coronary disease
  • hypertension due to phaeochromocytoma - as no Rx effect in this situation
  • beta-blocker withdrawal
  • ophthalmological monitoring, contact lens use
  • surgery (anaesthesia)
  • pregnancy (cat B3 - in some circumstances the incidence of embryonic and perinatal deaths was increased )
  • lactation (excreted in human milk, should not use)
  • children, adolescents (not recommended esp with ADHD and concomitant methylphenidate)

Adverse effects

  • sinus bradycardia
  • orthostatic hypotension
  • Raynaud's phenomenon
  • drowsiness, dry mouth, constipation, nausea, salivary gland pain, vomiting
  • uncommonly, allergic reaction, erectile dysfunction, fatigue, dry eyes, dry nose, headache, depression, sleep disorder, delusional perception, hallucination, nightmare
  • rarely, AV block, alopecia, hepatitis, paraesthesiae, gynaecomastia, colonic pseudo-obstruction

dose

oral

  • Initially: 75 mcg 2-3 times daily; incr daily dose by 75 mcg increments according to response; max 900 mcg/day.
  • Maintenance: 150-300 mcg 3 times daily

parenteral

  • Admin by SCI, IMI (undiluted, with patient in recumbent position) or IVI (in normal saline 10 mL over 5 min)
  • 150-300 mcg; may repeat at 3-6 hr intervals
    • Renal, hepatic impairment: may require dose reduction, but for dialysis patients, only a minimal amount of clonidine is removed during routine haemodialysis, thus there is no need to give supplemental clonidine following dialysis
    • Following intravenous injection an initial pressor phase of 5-10 mmHg lasting approximately 5 minutes may occur. This can be avoided by giving a slower rate.
clonidine.txt · Last modified: 2017/01/08 05:47 by 127.0.0.1

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