Clonidine withdrawal syndrome

Dobrydnjov I, Axelsson K, Berggren L, et al Intrathecal and oral clonidine as prophylaxis for postoperative alcohol withdrawal syndrome a randomized double-blinded study. Anesth Analg 98 738—744, 2004... 

Goodman WK, Charney DS, Price LH, et al Ineffectiveness of clonidine in the treatment of the benzodiazepine withdrawal syndrome report of three cases. Am J Psychiatry 143 900—903, 1986... 

There are two main treatments for the opiate withdrawal syndrome. One is replacement therapy with methadone or other X agonists that have a longer half-life than heroin or morphine, and produce mild stimulation rather than euphoria. They also produce cross-tolerance to heroin, lessening heroin s effect if patients relapse. Withdrawal is also treated with the 0C2 agonist clonidine, which inhibits LC neurons, thus counteracting autonomic effects of opiate withdrawal — such as nausea, vomiting, cramps, sweating, tachycardia and hypertension — that are due in part to loss of opiate inhibition of LC neurons. 

Gossop M (1988) Clonidine and the treatment of the opiate withdrawal syndrome. Drug Alcohol Depend 21 253-259... 

Wilson, M.F., Haring, O., Lewin, A., Bedsole, G., Srepansky, W., Fillingim, J., Hall, D., Roginsky, M., McMahon, F.G., Jagger, P., and Strauss, M. (1986) Comparison of guanfacine versus clonidine for efficacy, safety and occurrence of withdrawal syndrom in step-2 treatment of mild to moderate essential hypertension. Am J Cardiol 57 43E-49E. 

Clonidine 0.003-0.01 bid or tid Tourette s syndrome ADHD Aggression/self-abuse Severe agitation Withdrawal syndromes Sedation (very frequent) Hypotension (rare) Dry mouth Confusion (with high dose) Depression Rebound hypertension Localized irritation with transdermal preparation... 

Amineptine increases the release and reduces the reuptake of dopamine, and it is therefore not surprising that an amphetamine-like drug dependence has been reported (3-5). A withdrawal syndrome occurs and can be improved by clonidine (SEDA-16, 8). 

A withdrawal syndrome with rebound hypertension has been reported with methyldopa (12). Although it is similar to that associated with clonidine, it is less well defined, less severe, and less freqnent. 

Unlike clonidine, moxonidine does not appear to cause sedation or to impair psychomotor performance or cognitive function. However, possible potentiation of the effect of benzodiazepines can ocenr. There is no evidence of a withdrawal syndrome or rebonnd hypertension associated with sudden withdrawal. 

One of the limitations of clonidine treatment is that it does not appear to reduce the duration of the opioid withdrawal syndrome. In one study, 10 days of clonidine therapy were required to suppress the symptoms of opioid withdrawal from long-acting opioids such as methadone (70). 

Side effects of clonidine therapy include dry mouth, drowsiness, sedation, and constipation. Abrupt discontinuation of therapy may result in a withdrawal syndrome manifested as restless and headache in addition to significant rebound hypertension. Withdrawal can be avoided by tapering therapy over 2-4 days. The incidence of a local dermatitis or an extended dermal reaction with use of the transdermal patch is 15-20%. 

Dehpour AR, Samini M, Arad MA, Namiranian K. Clonidine attenuates naloxone-induced opioid-withdrawal syndrome in cholestatic mice. Pharmacol Toxicol 2001 89 129-132. 

Treatment of sedative-hypnotic withdrawal involves administration of a long-acting sedative-hypnotic (eg, chlordiazepoxide or diazepam) to suppress the acute withdrawal syndrome, followed by a gradual reduction of the dose. Clonidine or propranolol may also be of value to suppress sympathetic overactivity. 

Overall, although the frequency of troublesome adverse effects produced by guanfacine is similar to that produced by clonidine and the other centrally acting sympatholytics, their incidence and severity are lower with guanfacine. Unlike clonidine, abrupt discontinuation of guanfacine rarely results in rebound hypertension. When a withdrawal syndrome has occurred, its onset was slower and its symptoms less severe than the syndrome observed with clonidine. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Chronic non-malignancy pain oral or transdermal clonidine is less commonly used in the chronic setting for pain control due to the increased level of sedation. However, it may be helpful in managing patients who have been on high-dose narcotics as it has some efficacy in withdrawal syndromes. It can also be used for migraines. 

Drug withdrawal A withdrawal syndrome has been described after the use of remifenta-nil by infusion in intensive care units [166 ]. Within 10 minutes of withdrawal, patients experienced tachycardia, hypertension, sweating, mydriasis, and myoclonus. These symptoms persisted despite the use of morphine and clonidine and only resolved on readministration of remifentanil. Gradual tapering of remifentanil reduces the incidence of withdrawal symptoms. 

The answer is a. (Hardman, p 789. Katzung, pp 162—163.) Withdrawal of clonidine, particularly doses greater than 1 mg/d, is well known to cause such a syndrome (including severe hypertension, tachycardia, anxiety tremor, headache, abdominal pain, and sweating), even after one or two missed doses. 

Leckman, J.R, Ort, S., Caruso, K.A., Anderson, G.M., Riddle, M.A., and Cohen, D.J. (1986) Rebound phenomena in Tourette s syndrome after abrupt withdrawal of clonidine. Arch Gen Psychiatry 43 1168-1176. 

Restless legs syndrome was a feature of opioid withdrawal on days 3-4 in two heroin-dependent individuals (55). They were treated with levodopa and clonidine. 

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