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Key Points

  • Mechanism of Action (Saunders, Mictlan)
    • Stimulates alpha-2-receptors
      • Decreases sympathetic response, inhibiting vasoconstriction
      • Reduces blood pressure and heart rate
    • Metabolized by the liver
    • Clinical Use (Saunders)
      • Hypertension
        • Can be given orally or as a transdermal patch
          • Apply transdermal patch to a dry, hairless area on the upper arm or chest
          • Patch must be replaced every 7 days, rotate sites with each new patch
          • Wash hands before and after application
      • Opiate withdrawal
      • Severe pain in cancer patients
      • ADHD
    • Side Effects and Adverse Reactions (Saunders)
      • Severe rebound hypertension if abruptly discontinued
        • Due to the rapid surge of catecholamine secretion that was suppressed during therapy
        • The patch should never be taken off abruptly; must be tapered off over 2-4 days
        • Can lead to a hypertensive crisis
      • Dry Mouth
        • Medical term is xerostomia
        • Can use hard candy, chewing gum, or over-the-counter moisturizers to relieve dry mouth
      • Drowsiness
        • Avoid use with alcohol, opioids, and other CNS depressants
        • More common initially, will lessen with time
      • Dizziness
        • Dry mouth, drowsiness, and dizziness are often called the “3 D’s” of clonidine
      • Hypotension
        • Due to reduced sympathetic stimulation
        • Carefully monitor blood pressure and avoid giving concurrently with diuretics
      • Bradycardia
        • Due to reduced sympathetic stimulation
      • Abuse potential
        • Not recommended for patients with a history of opioid dependence
      • Teratogenic
        • Not recommended for pregnant women