Summary

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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