Cardiovascular Medicine Book

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Clonidine Withdrawal

Aka: Clonidine Withdrawal
  1. See Also
    1. Alpha Adrenergic Central Agonist
    2. Clonidine
    3. Clonidine Overdose
    4. Clonidine Withdrawal
  2. 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. 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
  4. Labs
    1. Urine Catecholamine increase (also seen with Pheochromocytoma)
    2. Serum Troponin
    3. Serum Creatinine
  5. Diagnostics: Consider based on findings
    1. Head CT
    2. Electrocardiogram
  6. 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
  7. Prevention
    1. Taper Clonidine over 7-10 days before discontinuation
  8. References
    1. Mishler and Lovecchio (2017) Crit Dec Emerg Med 31(11): 15-20
  9. Complications
    1. Myocardial Infarction
    2. Ventricular Tachycardia
    3. Hypertensive Emergency
  10. References
    1. Mishler and Lovecchio (2017) Crit Dec Emerg Med 31(11): 15-20

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