clonidine
Clonidine is a prescription medication that can be used to treat high blood pressure. It comes in 3 forms: topical patch, immediate-release tablet, and extended-release tablet. Clonidine usually isn't a first-choice option to treat high blood pressure because it can cause "rebound hypertension" (sudden rise in blood pressure) when the medication is suddenly stopped. Clonidine also isn't recommended for older adults since it can raise the risk for falls.
What is Clonidine?
What is Clonidine used for?
- High blood pressure
How Clonidine works
Clonidine is a type of medication called alpha agonist. It works in the brain to lower the activity of stress hormones, such as norepinephrine. By doing so, clonidine slows down your heart rate and relaxes your blood vessels. This allows for blood to easily flow throughout the body and brings down blood pressure.
Drug facts
Side effects of Clonidine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
The following side effects are those reported with immediate-release clonidine:
- Dry mouth (40%)
- Drowsiness (33%)
- Dizziness (16%)
- Constipation (10%)
- Feeling low energy (10%)
Please note: Side effects for Nexiclon XR are similar to that of immediate-release clonidine
The following side effects are those reported with clonidine patch:
- Itchy rash (26%)
- Dry mouth (25%)
- Drowsiness (12%)
- Blisters (7%)
- Feeling tired (6%)
- Headache (5%)
- Skin becomes darker (5%)
Less Common Side Effects
- Skin swelling, burning, or pain (clonidine patch)
- Feeling sluggish
- Feeling low energy
- Trouble sleeping
- Difficulty with sex
- Dizziness
- Sore throat
- Constipation
- Nausea
- Changes in taste
- Nervousness
- Fever
Clonidine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Dangerously high blood pressure (from withdrawals): Nervousness, agitation, headache, tremor, feeling delirious, sudden confusion, trouble speaking, seizures
The following Clonidine side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
blistering, burning, crusting, dryness, or flaking of the skin
chest pain or discomfort
confusion as to time, place, or person
decreased urine output
dilated neck veins
drowsiness
fast, pounding, or irregular heartbeat or pulse
general feeling of discomfort or illness
holding false beliefs that cannot be changed by fact
hyperventilation
irregular breathing
irritability
itching, scaling, severe redness, soreness, or swelling of the skin
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lightheadedness, dizziness, or fainting
mental depression
paleness or cold feeling in the fingertips and toes
pounding, slow heartbeat
problems in urination or increase in the amount of urine
raised red swellings on the skin, lips, tongue, or in the throat
restlessness
seeing or hearing things that are not there
shaking
shortness of breath
skin rash
swelling of the face, fingers, feet, or lower legs
tightness in the chest
tingling or pain in the fingers or toes when exposed to cold
trouble with sleeping
troubled breathing
unusual excitement, nervousness, or restlessness
unusual tiredness or weakness
vivid dreams or nightmares
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Dizziness (extreme) or faintness
feeling cold
pinpoint pupils of the eyes
unusual tiredness or weakness (extreme)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Clonidine
Pros
- Can be take along with other other blood pressure medications to help manage blood pressure
- Available in a once-weekly patch for people who can't take medicine by mouth
- Immediate-release tablets and patches available as lower-cost generics
Cons
- Taking it with alcohol can cause excessive sleepiness
- Can raise the risk for falls in older adults
- Can cause dangerously high blood pressure if stopped too suddenly or if a dose is missed
Pharmacist tips for Clonidine
- How to apply clonidine patches: Wash and dry your hands, then take off the adhesive liner on the back of the patch. Make sure the skin is clean and dry where you're applying the patch. Press the patch down firmly to make sure all edges are sticking. Wash your hands after application to prevent accidentally exposing others to the medication.
- You can wear your clonidine patch while showering, bathing, or swimming.
- The clonidine patch also comes with an adhesive cover that's meant to be placed over the patch if it ever becomes loose. This adhesive cover doesn't contain any medication.
- You might experience application site reactions — such as rash, itching, and swelling — on your skin where you applied clonidine patches. If you experience these reactions with clonidine patches, you're also likely to experience them with clonidine tablets. Let your provider know right away if you have allergic reactions to this medication.
- If you have heart problems (e.g., heart attack, stroke) or kidney problems, let your provider know before starting clonidine. Your provider might need to raise your dose of clonidine more slowly to make sure this medication is safe for you.
- Before starting any new medications, let your provider know. They can help you check to make sure it's safe to take those medications with clonidine or let you know what possible side effects to watch out for. Clonidine can interact with certain medications, such as certain blood pressure or mood medications.
- Don't drive a car or operate machinery until you know how clonidine affects you. Avoid taking clonidine with alcohol since this combination can lead to excessive sleepiness.
- If you have a surgery scheduled, your provider might ask you to temporarily stop clonidine tablets 28 hours before the operation. Your surgical team will monitor your blood pressure during the surgery to make sure it doesn't rise too high.
- Clonidine patches contain aluminum and can cause skin burn during magnetic resonance imaging (MRI). Consider other forms of imaging, such as ultrasound or X-ray, if you have recently applied a new patch. Talk with a provider or radiologist about your medication history before getting any testing done.
Common questions about Clonidine
You can apply clonidine patches to clean, dry, and hairless areas of skin on your upper outer arm or chest. Don't apply the patch to areas where you just put on lotion or cream, or to skin that's bruised, red, irritated, or cut. If you've already used an area of skin, choose a different area for the next week so that your skin won't get as irritated.
Some people who took clonidine reported dry eye as a side effect. Others have reported blurry vision or a burning sensation in the eyes. If you notice changes to your vision or other eye problems, let your provider know. They might recommend eye drops for your eyes or talk with you about other blood pressure medication options.
It's not clear whether clonidine is safe to use in pregnancy or breastfeeding. Clonidine hasn’t been studied in pregnant people, but animal studies suggest that this medication might weaken bones in pregnant mothers. In addition, clonidine can pass into breastmilk. If you’re pregnant or breastfeeding, talk to your provider so you can discuss the risks of taking clonidine.
Nexiclon XR and Kapvay are both medications that contain extended-release clonidine. But they are not interchangeable, meaning you can't replace one with another. The main difference between the two medications is what each medication is used for. Nexiclon XR is approved to treat high blood pressure, while Kapvay is approved to treat attention-deficit hyperactivity disorder (ADHD). Please note that Nexiclon XR for blood pressure is only available as a brand-name product, while Kapvay for ADHD is available as both brand-name and generic tablets.
Clonidine is only FDA-approved to lower high blood pressure. But some studies show that it can help ease hot flashes and night sweats. If you have questions about how well clonidine works for hot flashes, discuss with your provider.
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Risks and warnings for Clonidine
Clonidine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Withdrawal
- Risk factors: Taking clonidine with beta-blockers | Taking higher doses of clonidine
Stopping clonidine too suddenly can lead to side effects, such as high blood pressure, nervousness, agitation, headache, and tremor. Sometimes these symptoms can be life-threatening. Your risk is higher if you're taking a higher dose of clonidine or if you're also taking beta-blockers, such as carvedilol (Coreg). Don't stop clonidine without first talking to your provider. If you need to stop this medication, your provider can help you lower your dose slowly over time.
If you or your child have stomach problems that result in frequent vomiting, talk with your provider. Vomiting can prevent your body from absorbing clonidine tablets, which puts you at higher risk of withdrawal symptoms.
Sleepiness and dizziness
- Risk factors: Using alcohol | Taking other medications that cause drowsiness
Clonidine can cause you to be sleepy or dizzy, which can raise your risk for falls. The risk for these side effects is higher if you drink alcohol or if you take medications that make you drowsy, such as opioids, sleep medications, or certain antidepressants. Don't drive a car or operate machinery right after using this medication. If you experience symptoms such as lightheadedness, confusion, dizziness, or excessive drowsiness, get medical attention right away.
Heart problem
- Risk factors: Older adults| Also taking other medications that slow the heart
There have been reports that clonidine can cause heart beat or rhythm problems. The risk is higher if you're taking other medications that also slow heart rate (e.g., diltiazem (Cardizem), verapamil). Your provider might monitor your heart rate while you are taking clonidine with these medications to make sure they are safe for you. Talk to your provider if you frequently feel dizzy, tired, or run out of breath easily after using clonidine.
Skin reactions (clonidine patches)
Let your provider know right away if you notice a skin reaction, such as rashes or blisters, after you apply the clonidine patch. Depending on how serious the reaction is, your provider might switch you to a different medication.
Make sure to remove your clonidine patch before getting a magnetic resonance imaging scan (MRI). Not doing so can result in skin burns.
Clonidine dosage
Carton| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4 patches of 0.1mg per day | 1 carton | $37.04 | $37.04 |
| 4 patches of 0.2mg per day | 1 carton | $44.05 | $44.05 |
| 4 patches of 0.3mg per day | 1 carton | $51.13 | $51.13 |
Typical dosage for Clonidine
Immediate-release tablets
- The typical starting dose is 0.1 mg by mouth twice daily. Your provider might raise your dose weekly, depending on how your body responds to this medication. The typical maintenance dose ranges from 0.2 mg to 0.6 mg daily, but taken in divided doses throughout the day.
Extended-release tablets (Nexiclon XR)
- The typical starting dose is 0.17 mg by mouth once daily. Your provider might raise your dose weekly, depending on how your body responds to this medication. The typical maintenance dose ranges from 0.17 mg to 0.52 mg once daily.
Patches (Catapres‑TTS)
- The typical starting dose is to apply one 0.1 mg patch onto the skin once weekly. Your provider might raise your dose every 1 to 2 weeks, depending on how your body responds to this medication. The maximum recommended dose is to apply two 0.3 mg patches once weekly.
Your dose might be different if you have kidney problems.
Interactions between Clonidine and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Amitriptyline
- Amoxapine
- Atenolol
- Betaxolol
- Bevantolol
- Bisoprolol
- Carteolol
- Celiprolol
- Ceritinib
- Clomipramine
- Crizotinib
- Desipramine
- Dilevalol
- Diltiazem
- Dothiepin
- Doxepin
- Esmolol
- Imipramine
- Iobenguane I 131
- Levobunolol
- Lofepramine
- Macimorelin
- Metipranolol
- Metoprolol
- Mirtazapine
- Nadolol
- Nebivolol
- Nortriptyline
- Oxprenolol
- Penbutolol
- Pindolol
- Propranolol
- Protriptyline
- Sotalol
- Tertatolol
- Timolol
- Trimipramine
- Verapamil
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cyclosporine
- Fluphenazine
- Mepivacaine
- Naloxone
- Yohimbine
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