Clonidine (epidural route)

Clonidine epidural injection is used in conjunction with other pain medication to treat pain in cancer patients.

Overview

Clonidine epidural injection is used in conjunction with other pain medication to assist in pain relief in cancer patients. The drug is administered via infusion into the patient’s spine.

The medication comes in solution form in injection and can only be given under direct medication supervision, usually in a clinic or hospital setting. When your response to the medication has been monitored for a short time, your treating physician may decide that you can receive your treatment in your own home.

Clonidine is not suitable for use as a pain reliever following or during surgical procedures, nor should it be used for pain control during or after labor.

In the US, clonidine epidural injection is sold under the brand name, Duraclon and is only available on prescription from your GP or specialist physician.

Conditions treated

• certain forms of cancer

Type of medicine

• epidural injection
• analgesic

Side-effects

In addition to their desired properties, some drugs can cause a few unpleasant side effects. Not everyone notices any side effects, but if you do experience any unpleasant feelings after you have begun your course of treatment with clonidine epidural injection, you may require further medical treatment. If you notice any of the following effects, consult your treating specialist or GP immediately:

• vomiting
• slow heartbeat
• rapid heartbeat
• mental depression
• hallucinations
• fever
• extremely slow or shallow breathing
• excessive sleepiness
• dizziness, light-headedness, or fainting
• chest pain

Some patients who are having treatment with clonidine epidural injection notice side effects that do not usually need further medical attention. Many times these effects simply disappear as the body acclimatizes to the drug. There may also be ways in which you can lessen their effects, and your nurse or treating specialist will advise you on this. If any of the unwanted effects become unbearably troublesome, have a chat with your GP.

The following side effects caused by clonidine epidural injection are generally self-resolving:

• weakness
• unusual sweating
• tinnitus
• nausea
• dry mouth
• drowsiness
• constipation
• confusion
• anxiety

Even after your course of treatment with this drug has been completed, you may still find that you experience a few side effects that need further attention. If your side effects persist after your treatment has finished, or if you experience any effects that are not mentioned here, consult your GP for more advice.

Dosage

Clonidine epidural injection is administered by a nurse or other trained medical practitioner. The drug is given via an epidural infusion, introduced to the area surrounding the patient’s spinal cord by a special infusion pump.

Your medical team will check the pump and its tube regularly to ensure that the flow of the drug has not altered or ceased accidentally. Your nurse should also inspect the treatment site frequently to make sure that there are no indications of an infection.

You may be able to use this medication in your own home. However, before attempting to do so, make sure that you have been shown how to use it and that you are able to do so confidently.

The dose of clonidine epidural injection that you are given will vary between patients. When measuring your dose, you should follow the instructions shown on the prescription label or the directions given to you by your treating physician. The dosage information that follows is based on the average for this medication. If you find that your dose is different, do not alter it, unless your treating physician tells you to.

The dose of clonidine epidural injection that you are prescribed will be determined by the strength of the formula that you are given, as well as the medical condition that you are being treated for. The same applies to the number of daily doses you take, the time you should leave between doses, and the duration of your course of treatment.

For pain relief – epidural injection:

• Adults: 30 mcg via continuous infusion over one hour’s duration
• Children: dose is determined by a doctor, based on the patient’s body weight

If you miss a dose of your medication, you should contact your pharmacist or GP. If you notice that your infusion of clonidine has stopped, tell your nurse immediately.

Note that this medication is generally only used in children where the pain is extreme and other forms of analgesia have failed to be effective.

Interactions

Some drugs can never safely be used together, although in some cases it may be necessary to use two or more different medications at the same time, even if this could cause an interaction between them. If this is the case, your doctor might decide to alter the dose of one or more of your medicines, or may suggest ways in which you can mitigate any interactions.

During the course of your treatment with clonidine epidural injection, you should tell your doctor if you are or have recently taken any of the drugs on the following list. It is not usually recommended to use any of the following medications with clonidine epidural injection:

• Verapamil
• Trimipramine
• Timolol
• Tertatolol
• Sotalol
• Protriptyline
• Propranolol
• Pindolol
• Penbutolol
• Oxprenolol
• Nortriptyline
• Nebivolol
• Nadolol
• Mirtazapine
• Metoprolol
• Metipranolol
• Lofepramine
• Levobunolol
• Imipramine
• Esmolol
• Doxepin
• Dothiepin
• Diltiazem
• Dilevalol
• Desipramine
• Crizotinib
• Clomipramine
• Celiprolol
• Carteolol
• Bisoprolol
• Bevantolol
• Betaxolol
• Atenolol
• Amoxapine
• Amitriptyline
• Acebutolol

Although clonidine epidural injection may be used with the following drugs if your doctor thinks that this is the best treatment in your case, an increased risk of side effects may occur as a result. To help prevent an interaction, your GP may change the frequency or dose of one or more of these medicines:

• Yohimbine
• Naloxone
• Mepivacaine
• Fluphenazine
• Cyclosporine

Note that some drugs may cause an interaction if they are taken around meal times or when drinking alcohol or using tobacco. If you smoke, drink alcohol, or have a preference for certain foodstuffs, you should mention this to your doctor.

Warnings

Always tell your doctor if you are aware of any allergies that you may have to clonidine or to any other prescription or non-prescription medication, including vitamin pills, and natural herbal products.

Do not stop using clonidine epidural injection unless you are under the direct supervision of a medical professional. Serious side effects could occur if the drug is withdrawn suddenly.

Clonidine can exacerbate the effects of central nervous system depressants and alcohol, making you feel sleepy and less alert. Consult your doctor if you are intending to use any CNS depressants during the course of your treatment with this drug.

Some people experience dizziness and fainting when receiving treatment with clonidine epidural injection. To avoid this problem, be sure to get up slowly from a seated or lying down position.

Clonidine can have the effect of making some patients feel sleepy or less alert than they would be usually. Do not drive or operate machinery until you know how this medication will affect you.

Some existing health conditions or a history of them may influence how this medication works. Always tell your GP if you have any history of the following medical conditions.

Bleeding problems or treatment with anticoagulant therapy can present the risk that bleeding into the spinal cord may occur.

Treatment with clonidine can make certain heart conditions or blood vessel diseases worse.

Epidural injections can present a risk of infection at the injection site. This can pose an increased risk of developing an abscess or contracting meningitis.

The effects of clonidine can be increased in patients who have kidney disease, due to the slower removal of the drug from the body.

Clonidine should not be used to manage pain in patients who have undergone surgery or following childbirth. This medication can lower the body’s ability to tolerate side effects that the drug may cause.

There is no evidence to suggest that using clonidine can cause harm to the unborn baby. However, you should discuss the pros and cons of having treatment with this drug with your GP if you are pregnant or if you are intending to become pregnant during the course of your treatment.

Research has shown that this medication can change breast milk composition or alter milk production. If you decide to continue breastfeeding while you are having treatment with clonidine, you should monitor your infant closely in case of side effects. It may be advisable to discontinue breastfeeding while you are receiving clonidine. Ask your midwife for advice on alternative feeding options during this time.

Storage

If you are intending to use clonidine epidural injection at home, you must store it correctly. Keep the medication in a sealed container and at room temperature. Do not place the medicine near to heat sources or in direct sunlight. Do not keep the medicine in the fridge and do not freeze it.

Make sure that the medication cannot be access by pets or children. If a pet does consume clonidine epidural injection solution, contact your emergency vet without delay.

Never stockpile clonidine epidural injection solution as it may go out-of-date.

You should never pour any unused clonidine solution down the toilet or into the drains. Nor should you dispose of any unwanted medication by throwing it out with your trash where children or pets could find it.

If you are unsure of how to get rid of any clonidine solution that you no longer need, ask your GP or pharmacist for instructions on the safe disposal of your unwanted medication.

Summary

Clonidine solution is given as an epidural injection together with other analgesic drugs in order to provide effective pain relief for cancer patients. The drug is administered to the patient through an infusion into the patient’s spine.

Clonidine is not used to provide pain relief associated with surgical procedures, nor should it be used for pain control during or after childbirth.

The medication does sometimes cause a few side effects in a small number of patients, but it is generally safe to use, and it does provide very effective pain relief for cancer sufferers. However, there are a large number of drugs that will cause an interaction if used together with clonidine. There are also some medical conditions that can be exacerbated through the use of clonidine. For these reasons, it is very important that you attend your treating physician for regular progress checks to make sure that the drug is working properly and that you are not experiencing any undetected, unwanted side effects.