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Clonidine Withdrawal

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Clonidine Withdrawal

  • 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
  • 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
  • Labs
  1. Urine Catecholamine increase (also seen with Pheochromocytoma)
  2. Serum Troponin
  3. Serum Creatinine
  • Diagnostics
  • Consider based on findings
  • 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
  • Prevention
  1. Taper Clonidine over 7-10 days before discontinuation
  2. Taper Beta Blockers off several days before discontinuing Clonidine
  • 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]