Side effects of clonidine

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. 

As indicated, buprenorphine can offer a quicker option than methadone, with a three-day course reported to be effective for withdrawal from heroin (Cheskin et al. 1994). The side-effects of clonidine which render it unsuitable for community treatment can be manageable in the inpatient setting, although the drug is being superseded by lofexidine where that is available. Controlled studies have found clonidine and lofexidine to be equally effective in alleviating withdrawal symptoms in inpatient detoxification from heroin (Lin et al. 1997) and from methadone (Khan et al. 1997), with lofexidine resulting in less hypotension and fewer adverse effects. Another double-blind controlled study found lofexidine to be broadly as effective as a ten-day methadone detoxification in inpatient opiate withdrawal (Bearn et al. 1996). 

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%. 

The most common side effect of clonidine is dose-dependent sedation that usually subsides after 2 to 3 weeks of therapy. Of concern are reports of bradycardia, rebound hypertension, heart block, and sudden death. Four children have died on the combination of methylphenidate and clonidine however, complicating factors make it impossible to link the drug combination directly with the cause of death. Of 10,060 children exposed to clonidine and assessed by a poison control center over a 7-year period, moderate (19%) to major (2%) toxic effects (bradycardia, hypotension, and respiratory depression) including one death were reported. Overdoses, concurrent clonidine and stimulant administration, as well as missed doses of clonidine aU add to the risk of adverse cardiovascular events. Similar adverse-effect concerns apply to treatment with guanfacine, although its U2a selectivity may result in less sedation and hypotension than clonidine. ... 

Such a correlation has never been shown when affinities for a 2-adrenoceptors were taken into account. There is a large body of evidence for the involvement of non-adrenoceptors in the induction of the hypotensive effect of imidazoline-related dmgs (Bousquet, 1995, 1997 Erns-berger et al., 1997 Molderings, 1997). Nevertheless, one should keep in mind that the main side effects of clonidine-like drugs are clearly due to their capability of acti-... 

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. 

Clonidine is an agonist at a - and o 2-adreno-ceptor subtypes. It reduce the sympathetic tonus and is thereby a useful antihypertensive drug. Clonidine can induce sedation, depression and peripheral side effects like a dry mouth. Unspecific a-adrenoceptor blocking agents like tricyclic antidepressants can reduce the antihypertensice effect of clonidine. 

In mice with mutations in the a2A-receptor gene it was established that the a2A subtype mediates the analgesic and anesthesia-sparing effects of clonidine and dexmedetomidine, but unfortunately also the sedative and vasodepressor effects of these drugs (Lakhlani et al., 1997). Thus, it seems unlikely that new subtype-selective compounds will lack the major side-effects of the existing drugs. 

Handa F, Tanaka M, Nishikawa T, Toyooka H. Effects of oral clonidine premedication on side effects of intravenous ketamine anesthesia a randomized, double-blind, placebo-controlled study. J Clin Anesth 2000 12(l) 19-24. 

Dewandre PY, Decurninge V, Bonhomme V, Hans P, Brichant IF. Side effects of the addition of clonidine 75 microg or sufentanil 5 microg to 0.2% ropivacaine for labour epidural analgesia. Int J Obstet Anesth 2010 19(2) 149-54. 

Reduction in adverse events the dose-sparing effect of clonidine on other neuraxial medications can potentially minimize the overall side effects of the analgesic regimen. Micturation is not delayed by neuraxial clonidine as it is with the most commonly used neuraxial analgesics, namely local anesthetics and opioids. 

When clonidine is withdrawn abmpdy, patients may experience a rebound hypertensive phenomenon, whereia blood pressure rises rapidly to a level higher than the predmg level. These patients may experience symptoms of headache, tachycardia, agitation, and nervousness. If rebound hypertension occurs, resumption of clonidine therapy or adrninistration of phentolamine reduces the blood pressure. For clonidine withdrawal, the dose should be reduced gradually over a two-week period. The principal side effects are sedation, dry mouth, drowsiaess, di22iQess, and fatigue. 

Guanfacine. Guanfaciae, used ia patients having mild to moderate hypertension, can lower blood pressure 50/25 mm Hg (systoHc/diastoHc) ia hypertensive patients. Side effects such as sedation, dry mouth, and asthenia are less as compared to those of guanaben2 and clonidine. Guanfaciae reduces blood cholesterol and triglyceride and does not cause glucose iatolerance. 

Einally, clonidine should only be used by patients who can be counted on to take their medication reliably. Clonidine is first and foremost a medication used to treat high blood pressure. Clonidine lowers blood pressure and can slow the pulse rate. However, when clonidine is suddenly stopped, dramatic rebound effects can occur, including a rapid rise in blood pressure that can be dangerous. Patients who suddenly stop taking clonidine or who routinely forget to take their clonidine run the risk of severe side effects. These risks must be discussed with the patient prior to initiating... 

Side effects. Lassitude, dry mouth rebound hypertension after abrupt cessation of clonidine therapy. 

Moxonidine and rilmenidine are the only examples of moderately selective Ii-receptor stimulants which have been developed clinically. Since moxonidine and rilmenidine have much lower affinity for a 2-receptors than for Ii-receptors it may be hoped that they will display a more favourable pattern of side-effects than classic o 2-adrenoceptor stimulants such as clonidine, guanfacine and Q -methyl-DOPA. 

Clonidine has been put forward for many years as the prototype of selective agonists of central o 2-adrenoceptor agonists. More recently it has been shown to be a mixed agonist of both 2- and 11-receptors in the central nervous system. It is an effective antihypertensive which has been used on a large scale for several decades. Its use has greatly declined in recent years because of its poor tolerability when compared with more modern antihypertensives. Sedation, dry mouth and sexual impotence are the most obvious side-effects. 

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. 

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