II. Risk Factors

  1. More likely with doses >1.2 mg per day for longer use
  2. Significant withdrawal has occurred at doses of 0.1 mg daily after only 1 week
  3. Concurrent Beta Blocker use
    1. Consider tapering off Beta Blocker several days before stopping Clonidine
    2. Exaggerated hypertensive response related to unopposed Catecholamine-induced Vasoconstriction

III. Findings: Peak 2-4 days after Clonidine cessation

  1. Rebound Hypertension
  2. Diaphoresis
  3. Tachycardia (and Palpitations)
  4. Anxiety
  5. Insomnia
  6. Nausea and Vomiting

IV. Labs

  1. Urine Catecholamine increase (also seen with Pheochromocytoma)
  2. Serum Troponin
  3. Serum Creatinine

V. Diagnostics: Consider based on findings

VI. Management

  1. Option 1
    1. Prazosin 10 mg orally twice daily AND
    2. Atenolol 50 mg orally daily AND
    3. Chlordiazepoxide (Librium) 10 mg orally twice daily
  2. Option 2
    1. Propranolol AND
    2. Phentolamine AND
    3. Labetalol
  3. Option 3
    1. Vasodilator (e.g. Hydralazine, Nitroprusside) AND
    2. Beta Blockers

VII. Prevention

  1. Taper Clonidine over 7-10 days before discontinuation
  2. Taper Beta Blockers off several days before discontinuing Clonidine

IX. References

  1. Mishler and Lovecchio (2017) Crit Dec Emerg Med 31(11): 15-20
  2. Bailey (1976) Br Med J 1(6015):942-3 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window