Clonidine 

Overview

Clonidine was first intended to treat high blood pressure, but it is unusual action makes it beneficial for a variety of illnesses. Clonidine, on the other hand, was only licensed by the Drug Administration for use as an antihypertensive. Labeled usage refers to using a medicine for its authorized indications. In clinical practice, doctors often prescribe drugs for unlabeled (“off-label”) usage when published clinical research, case reports, or their own clinical experiences corroborate the therapy’ effectiveness and safety.

Clonidine has various off-label applications, including the treatment of attention deficit/hyperactivity disorder (ADHD), tic disorders, Tourette’s syndrome, sleep issues in children with ADHD are being addressed. Using stimulants throughout the day, treatment of aggressive kids with disruptive behavior problems, alcohol withdrawal, opiate (narcotic) detox, and restless leg syndrome. Clonidine may be used off-label in treating post-traumatic stress disorder (PTSD). In sufferers with PTSD, stress causes hyperactivity of their nightmares, fear, startled reflexes, and outbursts of fury are frequent symptoms of a malfunctioning neurological system. Clonidine may alleviate these symptoms by acting on the central nervous system.

Mechanism of action

Clonidine affects the brain stem by activating α-adrenergic receptors. This reduces activity in that region of the neurological system that governs heart rate and blood flow, hypertension, decreasing both heart rate and blood pressure.
The specific mechanism by which Clonidine acts in ADHD is uncertain. In regions of the brain that control attention, Norepinephrine and dopamine are two transmitters that play important roles in sustaining attention and concentration. Neurotransmitters are chemicals.

Neurotransmission is the passage of a signal from one neuron to another. ADHD may be attributed to the improper regulation of neurotransmission in the part of the brain that governs attention. Low levels of dopamine and norepinephrine may be linked to impaired concentration and ADHD symptoms. ADHD symptoms may be reduced using medications that increase norepinephrine and dopamine levels, such as amphetamines and methylphenidate (stimulants). Clonidine, a nonstimulant, may be useful in ADHD since it acts on α-adrenergic receptors in parts of the brain that govern attention.

Dosing Information

Clonidine is most often used in conjunction with a stimulant, such as Ritalin, to treat ADHD and Tourette’s syndrome, although it may also be taken alone. Clonidine dose varies based on its application from 0.1 to 0.3 milligrams each day. The dose for younger children might vary based on their weight, with the recommended daily dose for children is 3 to 5 μg/kg body weight. A youngster weighing 50 pounds (23 kilograms) with a 5 μg dosage would get 0.1 mg/day. The amount may be administered in divided doses of 0.05 mg twice every day.

Clonidine is also available as a skin patch (Catapres-TTS) with a transdermal administration mechanism. the drug is administered at a dose of 0.1, 0.2, or 0.3 mg/day, depending on the patch strength. For example, will administer 0.1 mg of clonidine into the body via the skin for 7 days. 

• The skin patch is placed once a week to a hairless region of the upper outer arm or chest. 
• Before beginning Clonidine, take your pulse and blood pressure to establish a baseline level. Measurements should be taken after increasing the dose and repeated every 4-6 weeks when the patient is stable at a consistent dose.
•  A doctor may conduct an electrocardiogram (ECG) to rule out any cardiac issues prior to taking Clonidine. Once the patient has stabilized while on Clonidine, the physician may repeat The ECG is used to check for any cardiac abnormalities caused by the drug. 
• Patients with a preexisting heart, Clonidine therapy is not appropriate for treating diseases such as heart rhythm issues for ADHD. 

Common Side Effects

The usual side effects of Clonidine include tiredness (which may be useful to counteract the sleeplessness). When Clonidine is used at nighttime, stimulants might cause dry mouth, constipation, sedation, and dizziness.

Patients may sometimes suffer headaches, nausea and vomiting, weakness, anxiety, restlessness, agitation, and vivid dreams or nightmares. Side effects often appear shortly after the medicine is begun or when the dosage is raised, it gradually decreases with sustained treatment.

Adverse effects and precautions

Patients should not suddenly cease Clonidine without first visiting their doctor. To minimize unpleasant effects, Clonidine should be reduced gradually over 2-4 days before discontinuing use. Sudden cessation may cause headaches, anxiety, agitation, tremors, and raised blood pressure are all possible side effects.

Clonidine may cause orthostatic hypotension, which is related to the medication’s impact on blood pressure varies with posture. Clonidine may inhibit vasoconstriction that adjusts for postural changes. As a consequence, blood pressure drops briefly, causing dizziness and fainting (orthostatic hypotension). Patients should be careful when rising unexpectedly. From a lying posture, the patient should first rise. Gradually transition to a sitting posture before standing. If the person feels lightheaded or dizzy, they should sit Wait around 60 seconds before rising up to let your blood pressure regulate.

Clonidine may influence the heart rate of certain people, causing intense and fast beats (palpitations). For certain people, the heart rate is relatively sluggish (bradycardia). If these symptoms persist after onset, Consult your physician.

In rare occasions, children who got the combination of methylphenidate and clonidine have died suddenly or had cardiac issues. A study of these instances for the cause of death revealed no direct relationship with the medication combination was discovered. The combination of clonidine and methylphenidate is usually considered safe. However, the recorded mortality led to the prescription of cardiac monitoring with ECG for youngsters taking clonidine.

Use in Pregnancy and Breastfeeding: Category C

There have been no well-controlled trials in pregnant women to assess the safety of Clonidine. Pregnancy and its consequences on the growing fetus remain unclear. Clonidine should be taken throughout pregnancy. Only if clearly recommended and both the physician and the patient agree that the advantages exceed the dangers.
Clonidine is secreted in human breast milk and is thus not suggested for breastfeeding mothers.

Possible Drug Interactions

The following summarizes the main drug interactions recorded with Clonidine and other medicines. 

• Clonidine may exacerbate the central nervous system’s depressed effects of other sedatives, such as alcohol, barbiturates, antihistamines, and other centrally acting medicines. 
• Combining Clonidine and alcohol, for example, may cause sleepiness and sedation. Patients should be cautious while driving or interacting in dangerous situations, such as operating equipment. 
• Clonidine with various cardiovascular drugs, such as digoxin, calcium channel blockers (for example, Calan), Beta-blockers (such as Inderal) may also have the effect of decreasing the heart rate. Patients should Inform their doctor about all of the drugs they are taking. 
• Beta-blockers (such as Inderal) Combining Clonidine with a beta-blocker, such as Inderal, may reduce the antihypertensive action of beta-blockers, closely checking blood pressure after beginning or ending Clonidine or beta-blockers. 
• Tricyclic Antidepressants (Example: Elavil), Elavil and other tricyclic antidepressants may interfere with Clonidine’ antihypertensive effects. It is unknown if the tricyclic antidepressant will counteract the effect of Clonidine when administered for ADHD or Tourette’s syndrome. 
• Verapamil (For example, Calan and Isoptin), the combination of Clonidine and verapamil might have cumulative effects as toxicities, such as heart block (atrioventricular block) Severe hypotension. 
• Clozaril (clozapine); Geodon Ziprasidone, and Seroquel (Quetiapine), the combination of these second-generation antipsychotics, Clonidine, an antihypertensive drug, Inderal (propranolol) may increase the risk of orthostatic hypotension and increase its consequences. 

Overdose

Clonidine overdoses may be lethal, particularly in young children. An acute overdose resulting in increased blood pressure often occurs, followed by low blood pressure, slow heart rate, respiratory depression, and poor vital signs, coma and convulsions. 

A suspected overdose calls for rapid medical assistance, and the victim should be transported to the ER for examination and treatment. Bring the suspected bottles of drugs to the emergency department with the patient, since the number of tablets taken may be calculated by the date. When the prescription was given, and how many pills were left in the bottle.

Special Considerations

• If you miss a dosage, take it as soon as possible, usually within 2-3 hours of the planned time. If it is near the next dose, Skip the missing dosage and continue with your usual dosing routine. Do not take double.
• Clonidine may be taken with or without meals.
• Do not quit Clonidine without first visiting your doctor. Clonidine should be reduced gradually before you quit.
• The Clonidine skin patch should be used once weekly. The patch is waterproof; bathe, shower, and Swimming should not harm the patch. If the patch becomes loose, use an adhesive overlay then apply Catapres-TSS over the patch to ensure that it remains on for the entire 7 days. If you experience redness, Consult your physician if you have irritation or a rash.
• Keep the medicine in the original labeled, light-resistant container, away from heat and moisture. Heat Moisture may promote the breakdown of your drug, causing it to lose its therapeutic effects.
• Keep your medications out of reach of youngsters.