Clonidine (Transdermal)

By slowing down the heart rate and relaxing the body's blood vessels so greater flow can be achieved, clonidine helps relieve some of the constriction attendant upon high blood pressure.

Overview

Clonidine is a prescription medication which is included in a class of drugs known as central alpha agonist hypotensive agents. It has a number of uses, including the treatment of Tourette's Syndrome, relief of menstrual pain, menopausal hot flashes, the cessation of smoking habits, alcohol abuse, restless leg syndrome, addiction withdrawal, cancer pain, and diabetes-associated diarrhea. However, it is probably used most commonly to treat high blood pressure in individuals who are unable to manage that condition through diet and exercise.

The way this medication works is to relax the blood vessels of the body, allowing greater circulation of blood throughout the body, and a consequently less constricted flow. At the same time, it also lowers the heart rate, so that the double effect becomes an effective relief for how hard the heart must work to pump blood.

When it is taken as a transdermal, a clonidine patch is worn for about a week at a time before a replacement patch is needed. Each time a new patch is applied, it should be in a different site than last time, so as to avoid excessive irritation of any single location on the body. Used patches should be folded in half and discarded in the trash, not flushed down a toilet. Your doctor will discuss with you exactly how transdermal patches are to be used at home.

Clonidine is sometimes used in combination with other drugs to increase its effectiveness in the body, but it is also used as a standalone medication in a number of applications. Whether it's used as a standalone or in combination will generally depend on the specific medical condition for which it is being prescribed.

Condition Treated

  • High blood pressure, ADHD, Menstrual period pain, Tourette's Syndrome

Type of Medicine

  • Central alpha agonists

Side Effects

Clonidine has been known to produce some unwanted effects in patients besides the beneficial effects imparted. The side effects reported by patients undergoing a program of treatment with clonidine have included symptoms which range from the very mild to the very severe. The most severe side effects should immediately be reported to a doctor, in case some kind of medical attention is necessary.

Those side effects listed below which are considered mild in nature do not generally call for any kind of medical attention at all, and will usually fade away all of their own accord, as your body becomes used to the routine of taking clonidine. The symptoms which are considered severe side effects following:

  • nosebleeds which persist, and are difficult to bring under control
  • disorientation or confusion
  • anxiety or irritability with no known cause
  • a feeling of lightheadedness, as though you are about to faint
  • severe chest pain
  • shortness of breath or difficulty breathing
  • irregular heartbeat
  • a very slow heart rate which is not normal for the patient
  • vision which is blurred or sometimes causes you to see double
  • a persistent pounding in the neck or ears
  • severe headaches which seem to persist.

Some of the less severe side effects which are possible when taking clonidine are the following:

  • constipation
  • drowsiness or weakness
  • occasional dizziness
  • dry mouth
  • loss of appetite
  • dry eyes and/or discomfort for contact lens users
  • problems with sleeping
  • unexplained nightmares.

One particular side effect for patients using clonidine is possible when a patient suddenly stops using clonidine without doctor approval or doctor recommendation. A withdrawal condition can be triggered by sudden discontinuation of clonidine, and this is recognizable when the following symptoms occur:

  • extreme nervousness or irritability
  • pounding headaches
  • uncontrollable tremors or shaking
  • a sudden rapid increase in blood pressure.

Needless to say, the side effects described above can be very dangerous for a patient, especially a sudden rise in blood pressure. When this happens, it's possible that a stroke could be triggered, or some types of heart problems. Never stop taking clonidine on your own, because in the most extreme circumstances, sudden withdrawal can be fatal. This is even more likely if you are taking a large dose of clonidine or if you are taking it in combination with other blood pressure medications called beta blockers.

Clonidine is a medication which can be used with complete safety, as long as you stick to the recommended dosage and the program of treatment as prescribed by your doctor.

Another potential side effect of taking clonidine is described in a 2014 report which the Journal of Addiction Medicine published. In this report, the dangers of combining clonidine with opioid narcotics such as methadone, heroin, or codeine are detailed. Authors of the report noted that clonidine has the potential to significantly boost and extend the opioid high induced by the narcotics, and at the same time, clonidine could reduce the amount of narcotics necessary to achieve a high in the first place.

Since clonidine is a drug which is far easier to obtain than some other drugs subject to abuse, it's highly advisable to make sure that you take only the medication provided by your pharmacist, and only in the patch dosage prescribed by your doctor. If you suspect that you may have become addicted to clonidine, or that you are abusing it in some way, these are the side effects which you should be on the lookout for:

  • a lack of ability to control your usage of clonidine
  • a tendency to completely ignore responsibilities and duties at work, in school, or at home because you prefer using clonidine
  • usage of your clonidine medication, even when you are aware that you have contracted physical or mental health issues
  • an increased tolerance for the medication, which prompts a need for greater and greater doses of clonidine in order to feel the effects of the medication
  • feeling withdrawal symptoms when you stop using the medication, or continuing to use clonidine simply to avoid the side effects of withdrawal.

Dosage

In its transdermal form, clonidine is administered via a patch which is applied to the skin. Your doctor will demonstrate how these patches should be applied before having you perform the process at home by yourself, and if you are not sure of the routine, make a point of asking for clarification when discussing the procedure with your doctor.

The site on the body where the patch is to be applied should be on the upper portion of one of the arms, or on the upper chest area. This location should have all hair removed, so as to avoid any problem with adherence to the site, and it should also be washed clean before the patch is applied, so there is no danger of foreign materials being present during absorption.

The backing of the patch should first be peeled away, and then the patch should be pressed and held for approximately 10 seconds to ensure that a good connection is made. The site chosen should be free of irritation, open sores, broken skin, or oily areas. In addition, the selected location should not be somewhere that has skin folds, or which will be flexed in some way by movement of the body. This would have a tendency to loosen the patch, and it might then fall off prematurely. If the patch does loosen up at some point during its 1-week period of medication, it is permissible to apply the adhesive cover which comes with each patch. This adhesive cover does not have any medicine in it, so it can be placed over the top of the patch itself without wasting any of the medication.

It should also be remembered that the hands must be washed after each patch application, so you don't have the medication on your fingers. If itching or redness develops around the patch site, the patch should be removed and re-applied at a different location. If the new location also exhibits signs of irritation, you should discuss this situation with your doctor, and he/she may recommend an alternative method of delivering the medication.

You should get into the habit of changing your patch at the same time each week, partly so your body becomes accustomed to the routine, and partly to help you remember to change it. You should never apply more than a single patch at a time unless your doctor has advised you to do so for some reason.

Interactions

Clonidine is known to interact with some other medications, and the way clonidine works in your body may be affected when it interacts with these other drugs. It's also possible for the reverse to be true, and the other medications which you are taking can be impacted by the presence of clonidine in your system.

It's important for your doctor to be aware of all the other medications you are taking, in case adjustments need to be made to either your dosage of clonidine or to the dosages of other medications. It's also possible that you may have to discontinue usage of one or more medications while you are taking clonidine, because the interactions may be severe.

For instance, when you take clonidine in conjunction with substances that act like sedatives, the side effects such as drowsiness and disorientation can become much more pronounced. Sedatives in this class include alcohol, some types of antidepressants, and barbiturates.

Some drugs which are used in the treatment of heart disease may also interact with clonidine, and produce unwanted side effects in a patient. Here's a partial list of some of the drugs which are known to interact to some extent with clonidine:

  • medications used to treat blood pressure (a.k.a. beta blockers), such as at atenolol, betaxolol, and acebutolol
  • calcium channel blockers which are used in many heart medications such as amlodipine, diltiazem, and felodipine
  • the specific medication for treating heart issues known as digoxin
  • those class of medications deemed to be antidepressants, particularly those classified as tricyclic antidepressants such as clomipramine, desipramine, and doxepin
  • pills used to aid in sleeping, such as Ambien
  • allergy medications
  • medications used in the treatment of anxiety, for instance Valium or Xanax
  • medications used in the treatment of seizures or convulsions, such as phenytoin and levetiracetam

Warnings

Before taking clonidine, you should talk to your doctor about any of the risks associated with this medication. If you suspect you may be allergic to clonidine, make sure to let your doctor know this, and if any of the symptoms of an allergic reaction should appear after you start taking clonidine, stop taking the drug immediately and contact your doctor. The most common symptoms of an allergic reaction are swelling throughout the facial area, or in the throat, nose, tongue, and lips. There may also be severe rashes or inflammation manifested on the skin in various locations around the body.

You may also be taking other medications which can have an impact when combined with clonidine, so make sure to provide your doctor with a full list of all other medications you're currently taking. This list should include all prescription medications, over-the-counter drugs, vitamins, and even herbal supplements, as well as all the dosages of each. Your doctor can use this list to review the potential for any kind of interactions between medications, and make adjustments as needed.

When clonidine is being considered as a treatment for your high blood pressure or other medical condition, your doctor will probably want to review your medical history before prescribing anything. During this medical history conversation, you should point out any past appearance of kidney disease, irregular heartbeat, slow heartbeat, second-degree atrioventricular blockage, or third-degree atrioventricular blockage.

Some people become drowsy when taking clonidine, or become subject to temporary disorientation. That makes it inadvisable for you to be driving a motor vehicle or operating heavy machinery for several hours after taking clonidine. When you are certain that you are completely alert again and any drowsiness has dissipated, you will probably be safe to perform your normal daily activities once again. This makes it also inadvisable to take any alcoholic beverages at the same time as using clonidine, because the alcohol can multiply the effects of drowsiness or loss of concentration.

If you anticipate having any kind of surgery performed in the near future, including oral surgery, you should inform your doctor or dentist that you are taking clonidine. In this situation, your doctor may want to discontinue usage of clonidine temporarily until whatever surgery was scheduled has been performed and concluded. Some patients have experienced very dry eyes after taking clonidine, and if this occurs in your own case, make sure to inform your doctor about it so that some eyedrops can be used to mitigate the condition. This is especially true of people who wear contact lenses, because the lenses cling directly to the surface of the eye.

There is an increased incidence of drowsiness and fatigue experienced by patients who are aged 65 and above. This in turn, can then lead to an increased potential for slipping and falling, since concentration is not what it should be, and some obvious dangers may be overlooked.

Women who are thinking of become coming pregnant or who are currently pregnant, should probably not take clonidine during the pregnancy, unless there is a clear indication it's needed even during pregnancy. It is known that clonidine is passed through breastmilk to a nursing infant, and for that reason it is inadvisable for women to breast-feed while on a treatment program of clonidine. In either case however, whether for pregnancy or for breast-feeding, a thorough discussion should be had with the family doctor about the potential risks and benefits of using clonidine at the same time.

Once you have begun a program of treatment which uses clonidine, you should not suddenly stop taking the drug, because that has been known to trigger some undesirable symptoms like withdrawal. If there is some urgent reason for suddenly discontinuing your treatment with clonidine, make sure to discuss that fact with your doctor and get instructions for how to safely discontinue usage.

If you find that taking clonidine causes you to be constantly nauseous and vomiting, you should mention this to your doctor as soon as possible. If your body is unable to absorb the beneficial ingredients of clonidine, it could instead trigger the withdrawal symptoms referenced above. This is especially a problem with children under the age of 18 years who are being treated with clonidine.

If you are a patient being treated for high blood pressure, make sure to continue taking your prescribed dosage of clonidine even if you feel well and your home blood pressure readings seem normal. Many patients who are prescribed a program of treatment using clonidine are obliged to continue taking the medication for most of their lives.

Storage

Clonidine patches should always be stored in a location which predominantly has a normal room temperature setting, and is not subject to extremes of cold or heat. There should also be no excessive humidity in the area where clonidine is stored, because moisture can degrade the effectiveness of the medication. This makes the bathroom medicine cabinet a poor choice for storage of clonidine, since bathing and showering frequently cause humid conditions to be in effect for long periods of time.

However, there are other important points to observe about storage of clonidine besides the room location and room conditions. It would be extremely dangerous for youngsters to obtain clonidine patches and play with them, place them in their mouths, or apply them to the skin, out of simple curiosity. Therefore, you must take steps to insure that your prescription medications are stored well out of the reach of all children, and all pets as well. A good rule of thumb is to store the patches somewhere high up, where children and pets cannot possibly access it, even if chairs or other climbing aids were to be used.

If you have unused patches, you will need to safely dispose of all of them so they don't become a hazard to anyone in the household. Flushing them down the toilet is not a good idea, and instead a more secure method of disposal should be adopted. Ask your pharmacist or doctor about the best way to dispose of unused clonidine patches, and if neither of these are available, you can also check on the FDA website which is maintained to advise about the safe disposal of medications. Many communities also have a medication take-back program, which makes it very easy for you to dispose of drugs. All you have to do is drop off your unused patches at the take-back center, and they handle the disposal for you.

Summary

There are several medical conditions which clonidine is used in the treatment of, including high blood pressure, attention deficit disorder, Tourette's Syndrome, menstrual pain relief, menopausal relief, withdrawal from narcotics, cancer pain, restless leg syndrome, and the cessation of the smoking habit.

Clonidine is often used as a standalone drug, but is also used in combination with other drugs as well to increase its effectiveness. There can be some severe and dangerous side effects associated with usage of clonidine, especially in situations where withdrawal symptoms are exhibited. It is possible to experience such symptoms of withdrawal if a patient suddenly stops taking clonidine without doctor approval. Emergency medical attention is called for in such cases, because the symptoms can escalate into a life-threatening situation, especially if blood pressure begins climbing out of control. Stroke and heart attack are also possible when severe withdrawal is in progress.

In its transdermal patch form, there is far less danger of overdosing on clonidine, because patch dosages are pre-measured of course, but there is still the possibility that an overdose could happen if more than a single patch is applied at once, or if a clonidine tablet is ingested while a patch is also working. If the signs of an overdose are suspected, immediate medical attention should be sought, because the consequences of an untreated overdose can be severe.

However, for the vast majority of patients, there are no such side effects or symptoms experienced. As long as a patient applies only a single patch of transdermal clonidine which has been prescribed by a doctor, and follows self-administration instructions closely, there are usually no serious side effects associated with taking the drug.

There are only a few other warnings which must be observed when a patient is being treated with clonidine, chief among them the fact that women who are pregnant or nursing must consult with a doctor about the risks vs. benefits of continuing treatment with the medication. There is a danger to an infant because clonidine is known to be passed through breast milk to a nursing baby, although the precise effects of ingestion are not known.

Clonidine is one of several drugs classified as central alpha agonists, and if a specific patient is unable to take clonidine for some reason, there are a few similar drugs which may be better tolerated by a patient who needs medication.