Clonidine monitoring

Clonidine may increase cyclosporine blood levels although only a single case report supports this, it would be prudent to monitor cyclosporine blood levels in a patient receiving clonidine. 

Clonidine Demonstrated efficacy in hot flash reduction in most trials Variety of dose regimens most common 0.1-0.4 mg daily Dry mouth, blood pressure lowering monitor blood pressure... 

Clonidine can attenuate the noradrenergic hyperactivity of opiate withdrawal without interfering significantly with activity at the opiate receptors. Monitoring should include blood pressure checks, supine and standing, at least daily. 

Clonidine c Second-line Titrate to response 0.2-0.75 mg per day 6-12 months Monitor baseline electrolyte and lipid profiles, renal function, uric acid complete blood count, and blood pressure. B2... 

The most common clonidine side effects are dry mouth, dizziness, sedation, and constipation. Blood pressure should be monitored. 

Antidepressants and clonidine are the most commonly used augmentation strategies for ADHD. If the patient has tics or is troubled by insomnia, clonidine is a reasonable choice. After collecting a baseline EKG, clonidine should be started at 0.05 mg at bedtime for children and adolescents and 0.1 mg at bedtime for adults. The dose can be increased every 2 weeks or so while monitoring the patient s blood pressure and pulse. Although it has not been studied as well, guanfacine may work in much the same manner as clonidine. 

Renal Impairment-Adjust dosage according to degree of renal impairment and carefully monitor patients. Because only a minimal amount of clonidine is removed during hemodialysis, there is no need to give supplemental clonidine following dialysis. 

Perioperative use Continue administration of clonidine to within 4 hours of surgery and resume as soon as possible thereafter. Carefully monitor blood pressure and institute appropriate measures to control it. If transdermal therapy is started during the perioperative period, note that therapeutic plasma levels are not achieved until 2 to 3 days after initial application. 

Renal/Hepatic function impairment Although the topical use of apraclonidine has not been studied in renal failure patients, structurally related clonidine undergoes a significant increase in half-life in patients with severe renal impairment. Close monitoring of cardiovascular parameters in patients with impaired renal function is advised if they are candidates for topical apraclonidine therapy. Close monitoring of cardiovascular parameters in patients with impaired liver function is also advised as... 

Inattentiveness, impulsivity, hyperactivity 50% will continue to manifest the disorder into adulthood Stimulants (70% response for uncomplicated ADHD caution in patients with tic disorders) TCAs (70% response, first line for patients with comorbid MD or anxiety disorders, and for patients with ADHD + tics) requires serum levels and cardiovascular monitoring Bupropion Clonidine, guan-facine (first line for patients with ADHD + tics) MAOIs Combined pharmacotherapy for treatment-resistant cases... 

Clonidine. This drug is now well established on the withdrawal of opiate addiction. However, due to its ability to produce postural hypotension and sedation, its use is often limited to in-patients. It is being used for out-patients in some centres but it is necessary to ensure daily contact with the patients so any side effects, particularly low blood pressure, can be monitored and this may be possible for example through the Community Psychiatric Nurse (CPN) of a Community Drugs Team. Further work is needed in its use for outpatients before it can be generally recommended. 

Caution [C, ] CrCl <30 Contra Component sensitivity, asthma, severe COPD, sinus bradycardia Disp Soln SE Irritation, bitter taste, superficial keratitis, ocular allergic Rxn EMS Drug is absorbed systemically OD May cause electrolyte disturbances (K), acidosis and bradycardia monitor ECG Doxazosin (Cardura, Cardura XL) [Antihypertensive/Alpha Blocker] Uses HTN symptomatic BPH Action < [-Adrenergic blocker relaxes bladder neck smooth muscle Dose HTN Initial 1 mg/d PO may be T to 16 mg/d PO BPH Initial 1 mg/d PO, may T to 8 mg/d XR 2-8mg qAM Caution [B, ] Use w/ PDE5 inhibitor (eg, sildenafil) can cause 1 BP Contra Component sensitivity Disp Tabs SE Dizziness, HA, drowsiness, sexual dysfxn, doses >4 mg T postural BP risk Interactions T Effects W/ nitrates, antihypertensives, EtOH i effects W/ NSAEDs, butcher s broom -t effects OF clonidine EMS Concurrent EtOH use can T drowsiness syncope may occur w/in 90 min of initial dose OD May cause profound hypotension place pt in supine position, give IV fluids, use pressors if needed... 

CENTRALLY ACTING ANTI HYPERTENSIVES -CLONIDINE ALPHA-BLOCKERS-PRAZOSIN Small case series indicate that prazosin may 1 the antihypertensive effect of donidine Uncertain at present Monitor BP at least weekly until stable... 

At this time, the preferred first-line drug therapy for ADHD is either methylphenidate, dexmethylphenidate, mixed amphetamine salts, or dextroamphetamine. Atomoxetine, bupropion, or TCAs are good options for those umesponsive to or unable to tolerate stimulants. Clonidine and guanfacine are third-line options or adjuncts that require careful cardiovascular monitoring. Mood stabilizers (e.g., lithium, divalproex, and carbamazepine) and atypical antipsychotics are adjuncts for control of aggression or comorbid bipolar disorder. Other agents require further investigation before their status in the treatment of ADHD can be fuUy determined. 

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