clonidine hydrochloride

(kloe' ni deen)
Antihypertensives:
Apo-Clonidine (CAN), Catapres, Catapres-TTS (transdermal preparation),
Dixarit (CAN), Nu-Clonidine (CAN)
Analgesic:
Duraclon

Pregnancy Category C

Drug classes
Antihypertensive
Sympatholytic (centrally acting)
Central analgesic

Therapeutic actions
Stimulates CNS alpha2-adrenergic receptors, inhibits sympathetic cardioaccelerator and
vasoconstrictor centers, and decreases sympathetic outflow from the CNS.

Indications
• Hypertension, used alone or as part of combination therapy
• Treatment of severe pain in cancer patients in combination with opiates; epidural
more effective with neuropathic pain (Duraclon)
• Unlabeled uses: Tourette's syndrome; migraine, decreases severity and frequency;
menopausal flushing, decreases severity and frequency of episodes; chronic
methadone detoxification; rapid opiate detoxification (in doses up to 17
mcg/kg/day); alcohol and benzodiazepine withdrawal treatment; management of
hypertensive "urgencies"; (oral clonidine "loading" is used; initial dose of 0.2 mg
then 0.1 mg every hour until a dose of 0.7 mg is reached or until BP is controlled)

Contraindications and cautions

• Contraindicated with hypersensitivity to clonidine or any adhesive layer
components of the transdermal system.
• Use cautiously with severe coronary insufficiency, recent MI, cerebrovascular
disease; chronic renal failure; pregnancy, lactation.

Available forms
Tablets—0.1, 0.2, 0.3 mg; transdermal—0.1, 0.2, 0.3 mg/24 hr; epidural injection—100
mcg/mL

Dosages
ADULTS
Oral therapy
Individualize dosage. Initial dose is 0.1 mg bid; for maintenance dosage, increase in
increments of 0.1 or 0.2 mg to reach desired response. Common range is 0.2–0.6 mg/day,
in divided doses; maximum dose is 2.4 mg/day. Minimize sedation by slowly increasing
daily dosage; giving majority of daily dose hs.
Transdermal system
Apply to a hairless area of intact skin of upper arm or torso once every 7 days. Change
skin site for each application. If system loosens while wearing, apply adhesive overlay
directly over the system to ensure adhesion. Start with the 0.1-mg system (releases
0.1 mg/24 hr); if, after 1–2 wk, desired BP reduction is not achieved, add another 0.1-mg
system, or use a larger system. Dosage of more than two 0.3-mg systems does not
improve efficacy. Antihypertensive effect may only begin 2–3 days after application;
therefore, when substituting transdermal systems, a gradual reduction of prior dosage is
advised. Previous antihypertensive medication may have to be continued, particularly
with severe hypertension.
Epidural injection
• Pain management: 30 mcg/hr by continuous epidural infusion.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak Duration
Oral 30–60 min 3–5 hr 24 hr
Transdermal Slow 2–3 days 7 days
Epidural Rapid 19 min

Metabolism: Hepatic; T1/2: 12–16 hr, 19 hr (transdermal system); 48 hr (epidural)

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
Oral therapy
• CNS: Drowsiness, sedation, dizziness, headache, fatigue that tend to diminish
within 4–6 wk, dreams, nightmares, insomnia, hallucinations, delirium,
nervousness, restlessness, anxiety, depression, retinal degeneration
• CV: CHF, orthostatic hypotension, palpitations, tachycardia, bradycardia,
Raynaud's phenomenon, ECG abnormalities manifested as Wenckebach period or
ventricular trigeminy
• Dermatologic: Rash, angioneurotic edema, hives, urticaria, hair thinning and
alopecia, pruritus, dryness, itching or burning of the eyes, pallor
• GI: Dry mouth, constipation, anorexia, malaise, nausea, vomiting, parotid pain,
parotitis, mild transient abnormalities in liver function tests
• GU: Impotence, decreased sexual activity, diminished libido, nocturia, difficulty
in micturition, urinary retention
• Other: Weight gain, transient elevation of blood glucose or serum creatine
phosphokinase, gynecomastia, weakness, muscle or joint pain, cramps of the
lower limbs, dryness of the nasal mucosa, fever
Transdermal system
• CNS: Drowsiness, fatigue, headache, lethargy, sedation, insomnia, nervousness
• GI: Dry mouth, constipation, nausea, change in taste, dry throat
• GU: Impotence, sexual dysfunction
 • Local: Transient localized skin reactions, pruritus, erythema, allergic contact
sensitization and contact dermatitis, localized vesiculation, hyperpigmentation,
edema, excoriation, burning, papules, throbbing, blanching, generalized macular
rash

Interactions
Drug-drug
• Decreased antihypertensive effects with TCAs (imipramine)
• Paradoxical hypertension with propranolol; also greater withdrawal hypertension
when abruptly discontinued and patient is taking beta-adrenergic blocking agents

Nursing considerations
CLINICAL ALERT!
Name confusion has been reported between clonidine and Klonopin
(clonazepam); use caution.
Assessment
• History: Hypersensitivity to clonidine or adhesive layer components of the
transdermal system; severe coronary insufficiency, recent MI, cerebrovascular
disease; chronic renal failure; lactation, pregnancy
• Physical: Body weight; T; skin color, lesions, temperature; mucous membranes—
color, lesion; breast exam; orientation, affect, reflexes; ophthalmologic exam; P,
BP, orthostatic BP, perfusion, edema, auscultation; bowel sounds, normal output,
liver evaluation, palpation of salivary glands; normal urinary output, voiding
pattern; liver function tests, ECG

Interventions
• Do not discontinue abruptly; discontinue therapy by reducing the dosage
gradually over 2–4 days to avoid rebound hypertension, tachycardia, flushing,
nausea, vomiting, cardiac arrhythmias (hypertensive encephalopathy and death
have occurred after abrupt cessation of clonidine).
• Do not discontinue prior to surgery; monitor BP carefully during surgery; have
other BP-controlling drugs readily available.
• Store epidural injection at room temperature; discard any unused portions.
• Reevaluate therapy if clonidine tolerance occurs; giving concomitant diuretic
increases the antihypertensive efficacy of clonidine.
• Monitor BP carefully when discontinuing clonidine; hypertension usually returns
within 48 hr.
• Assess compliance with drug regimen in a supportive manner with pill counts, or
other methods.

Teaching points
• Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the
drug unless so instructed. Do not discontinue abruptly; life-threatening adverse
effects may occur. If you travel, take an adequate supply of drug.
 • Use the transdermal system as prescribed; refer to directions in package insert, or
contact your health care provider with questions. Be sure to remove old systems
before applying new ones.
• Attempt lifestyle changes that will reduce your BP: stop smoking and using
alcohol; lose weight; restrict intake of sodium (salt); exercise regularly.
• Use caution with alcohol. Your sensitivity may increase while using this drug.
• These side effects may occur: Drowsiness, dizziness, light-headedness, headache,
weakness (often transient; observe caution driving or performing other tasks that
require alertness or physical dexterity); dry mouth (suck on sugarless lozenges or
ice chips); GI upset (eat small, frequent meals); dreams, nightmares (reversible);
dizziness, light-headedness when you change position (get up slowly; use caution
climbing stairs); impotence, other sexual dysfunction, decreased libido (discuss
with care providers); breast enlargement, sore breasts; palpitations.
• Report urinary retention, changes in vision, blanching of fingers, rash.

Adverse effects in Italic are most common; those in Bold are life-threatening.