Drowsiness clonidine

Clonidine (Catapres) is another drug used to treat opiate addiction. It can relieve the anxiety, runny nose, salivation, sweating, abdominal cramps, and muscle aches of opiate withdrawal. Side effects are dry mouth, dizziness, and drowsiness. Clonidine is initially taken at 0.8-1.2 mg a day, maintained for a few days, and then gradually decreased. Combined with the opiate blocker naltrexone, clonidine can allow a more rapid detoxification (the removal of morphine from the body). Detox in a single day can be accomplished by heavy sedation or anesthesia while giving naltrexone to an unconscious addict. This controversial method has not been studied in controlled trials. 

Clinically, clonidine has shown great versatility effective in mild, moderate and severe hypertension. The major side effects are drowsiness and dry mouth. Clonidine can be effectively used in combination with a diuretic(32). In addition, a vasodilator (hydralazine) can be usefully added. The brady-cardiac effect of clonidine prevents the reflex tachycardia induced by the vasodilator. 

The most common side effects of clonidine are constipation, dizziness, drowsiness, dryness of mouth, and unusual tiredness or weakness. However, there are more severe side effects that clinicians and patients should be aware of, such as allergic reaction, decreased heart rate, or unusually elevated or decreased blood pressure, as well as contraindications and drug interactions that should be evaluated prior to prescription. 

The most common side effect of clonidine is drowsiness. This can begin with the very hrst dose and usually goes away after a few weeks. Clonidine s sedating effects can actually be useful when it s taken at bedtime. Insomnia is a common problem for patients with ADHD either as a side effect of stimulants or as a consequence of rebound hyperactivity at night when the daytime dose of stimulant has worn off. Clonidine can help the ADHD patient with insomnia to go to sleep. Other side effects of clonidine include low blood pressure, dizziness, depression, dry mouth, nausea, and slowed heart rate. One important point to remember is that not only does clonidine not cause tics, it can, in fact, relieve tics when they appear in patients with ADHD. 

It is estimated that about 7% of patients receiving clonidine discontinue the drug because of side effects. Although the symptoms are generally mild and tend to subside if therapy is continued for several weeks, as many as 50% of the patients complain of drowsiness and dryness of mouth. Other untoward effects include constipation, nausea or gastric upset, and impotence. These effects are characteristic of interference with the functioning of the sympathetic nervous system. 

Clonidine is also available as a transdermal patch (Catapres-TTS [transdermal therapeutic system]) that has the advantages of avoiding the need for repeated doses during the day and of reportedly lower rates of dry mouth and drowsiness (Burris, 1993). Steady-state plasma levels are reached within 2-3 days after applying the patch and clonidine concentrations reportedly diminish gradually over 2-3 days following patch removal, without rebound hypertension in adult hyper-... 

Other medications, which will not be discussed in the following chapters, have psychotropic actions that are considered to be side effects or adverse effects. Thus, some antihistamines (Le. products used to counteract allergic reactions) induce fatigue and drowsiness, and the same applies to some myorelaxants. Older antihypertensives (Le. agents reducing blood pressure) such as alpha-methyldopa (Aldomet ) or clonidine (Catapres 1) can cause fatigue and depression. 

The most common adverse effects with clonidine are hypotension, dry mouth, drowsiness, and dermatoiogicai reactions. These are usually mild, but hypotensive effects may be significant in normotensive manic patients. Higher doses (e.g., 0.8 to 1.2 mg) have also been reported to induce a paradoxicai excitement in some patients (270). 

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... 

Clonidine 0,1 mg Once daily Can be administered orally or transdermally drowsiness and dry mouth can occur, especially with higher doses... 

Treatment with centrally acting agents is characterized by a relatively high incidence (up to 60% in some studies) of nervous system depressant effects (dizziness, drowsiness, tiredness, dry mouth, headache, depression), particularly during the initial period of treatment or after dosage increments. Sedation, lethargy, and tiredness are common with clonidine, particularly at the start of treatment (13). 

Transdermal clonidine (clonidine TTS) has been used with some success for the treatment of mild hypertension. Systemic adverse effects are similar to those seen after oral administration, but are less frequent and milder. They include dry mouth, drowsiness, headache, sexual disturbance, cold extremities, obstipation, and fatigue (31-33). These adverse effects rarely necessitate withdrawal of clonidine TTS. 

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%. 

Clonidine (Catapres) Acts in brain as postsynaptic a2-adrenergic agonist causing a reduction in sympathetic nervous system activity (decreased heart rate, cardiac ouput and blood pressure). Exact mechanism unknown. Mild to moderate hypertension. Rash, drowsiness, dry mouth, constipation, headache, impaired ejaculation. Rebound hypertension if withdrawn abruptly. To limit toxicity, start with low dose and increase slowly. 

Clonidine should be used with caution in patients with cerebral, or coronary insufficiency, Raynaud s disease or throraboangitis obliterans, or with a history of depression. The hypotensive effect may be antagonised by tricyclic antidepressants, and enhanced by thiazide diuretics. Clonidine cause drowsiness and patients should not drive or operate machinery where loss of attention could be dangerous. The effect of other central nervous system depressants may be enhanced, withdrawal of clonidine therapy should be gradual as sudden discontinuation may cause rebound hypertension which may be severe. Agitation,... 

An advantage of clonidine is the absence of orthostatic hypotension, but like a-methyldopa and reserpine it may cause drowsiness, and marked sedation occurs in up to 50% of patients treated in some series. Sedation can be so severe as to proceed to semi-consciousness. Nightmares and delusions are another expression of the drug s influence upon the central nervous system. Apart from sedation, the complaint of dry mouth and nose is the most common side effect recorded with clonidine administration. Dizziness, headache and fatigue are frequently mentioned, as well as anorexia, nausea, constipation and even pseudo-obstruction (94 ), anxiety, depression, drug fever and rashes. Side effects occur in 50—70% of the patients treated and are in some 20% the reason for discontinuation of therapy (3 , 13, 83 ). 

Clonidine may potentiate the effects of alcohol, sedatives and CNS depressants (102 ). High doses of clonidine combined with high doses of propranolol were in several cases associated with the development of nightmares, delusion and marked drowsiness (8 ). The combination of clonidine with the 3-adrenergic blocker Sotalol gave rise to an antagonistic effect, comprising a marked rise of blood pressure in 3 out of 6 cases so treated (103 ). 

---