CLONIPRESS Clonidine Hydrochloride 150mcg Tablet 100's
Indications/Uses
Dosage/Direction for Use
Mild to Moderate Hypertension: Initial Dose: 75-150 mcg oral twice daily, in the morning and at bedtime. Dose may be increased in increments of 150 mcg/day until optimum response is achieved. Maintenance Dose: Most common range is 200-600 mcg/day given in 2 divided doses. Maximum Dose: 2,400 mcg/day in 2-3 divided doses. Sedative effects may be minimized by giving bulk of the daily dose at bedtime.
Severe Hypertension: Initial Dose: Increase to 300 mcg 3 times daily (900 mcg/day total loading dose).
Overdosage
Other symptoms of clonidine overdosage are bradycardia, hypotension, CNS depression, respiratory depression, apnea, hypothermia, miosis, coma, seizures, lethargy, agitation, irritability, vomiting, hypoventilation, reversible cardiac conduction defects, arrhythmias, transient hypotension, profound hypotension, weakness, somnolence and diminished or absent reflexes.
Treatment: Naloxone may be a useful adjunct for the management of clonidine-induced respiratory depression.
Induction of emesis is usually not recommended because of rapid onset of CNS depression. Establish respiration if necessary, perform gastric lavage and administer activated charcoal. A saline cathartic (magnesium sulfate) will increase the rate of transport through the gastrointestinal tract. Routine hemodialysis is of limited benefit because a maximum of 5% of circulating clonidine is removed.
Supportive care may include atropine sulfate for the treatment of persistent bradycardia, and dopamine infusion and IV fluids for hypotension.
Hypertension can be treated with IV furosemide or diazoxide or α-blocking agents eg, phentolamine. Tolazoline, an α-blocker, in IV doses of 10 mg at 30-min intervals may reverse clonidine's effects if other efforts fail. Naloxone may be a useful adjunct for the management of clonidine-induced respiratory depression, hypotension or coma.
Administration
Contraindications
Special Precautions
Clonidine Discontinuation: Instruct patients not to discontinue clonidine therapy without consulting a physician. Abrupt withdrawal of clonidine treatment may result in symptoms eg, nervousness, agitation, headache and tremor followed by a rapid rise in blood pressure, and increase in plasma catecholamine concentration. Such occurrences have usually been associated with previous administration of high oral doses (exceeding 1,200 mcg/day) or with continuation of concomitant α-blocker therapy. Rare cases of hypertensive encephalopathy, cerebrovascular accidents and death have been reported after clonidine withdrawal. When discontinuing therapy, clonidine dose should be reduced gradually over 2-4 days to avoid withdrawal symptoms.
Use with caution in patients with severe coronary insufficiency, conduction disturbances, recent myocardial infarction or cerebrovascular disease and chronic renal failure.
Use in pregnancy & lactation: Pregnancy Category C: There are no adequate and well controlled studies in pregnant women. Use in pregnancy only if clearly needed.
Exercise caution when clonidine is administered to a breastfeeding woman as it can be excreted in human milk.
Use in children: Safety and effectiveness in pediatric patients <12 years have not been established.
Use In Pregnancy & Lactation
Exercise caution when clonidine is administered to a breastfeeding woman as it can be excreted in human milk.
Adverse Reactions
Cardiovascular: Syncope, congestive heart failure, orthostatic symptoms, palpitations, tachycardia, bradycardia, Raynaud's phenomenon, electrocardiogram (ECG) abnormalities (eg, sinus node arrest) manifested as Wenckebach period or ventricular trigeminy, conduction disturbances, arrhythmias, sinus bradycardia and atrioventricular block (rare).
Central Nervous System: Dreams or nightmares, insomnia, hallucinations, delirium, nervousness, agitation, restlessness, anxiety, depression, headache.
Dermatologic: Rash, angioneurotic edema, hives, urticaria, alopecia, pruritus.
Gastrointestinal: Abdominal pain, anorexia, malaise, nausea, vomiting, mild transient abnormalities in liver function tests, hepatitis, parotitis (rare).
Genitourinary: Impotence, decreased sexual activity, loss of libido, nocturia, difficulty in micturition and urinary retention.
Hematologic: Thrombocytopenia (rare).
Metabolic: Weight gain, transient elevation of blood glucose or serum creatinine phosphokinase (rare), gynecomastia.
Musculoskeletal: Weakness, fatigue, muscle or joint pain, cramps of the lower limbs.
Miscellaneous: Increased sensitivity to alcohol, dryness and itching or burning of the eyes, dryness of the nasal mucosa, pallor, fear, weakly positive Coombs' test, blurred vision.
Drug Interactions
Central Nervous System Depressants: Clonidine may be additive with or may potentiate the action of other CNS depressants eg, opiates or other analgesics, barbiturates, or other sedatives, anesthetics or alcohol. Concomitant administration of opiate analgesics with clonidine may also potentiate the hypotensive effects of clonidine.
Psychotherapeutic Agents: Tricyclic antidepressants (eg, imipramine, desipramine) may block the antihypertensive effects of clonidine and possibly life-threatening elevations in blood pressure may occur.
Beta-Adrenergic Blocking Agents: Concomitant administration with clonidine may result in attenuation or reversal of antihypertensive effect and potentially life-threatening increases in blood pressure.
Storage
Action
Orthostatic effects are mild and infrequent. The drug does not alter normal hemodynamic responses to exercise. Acute studies have demonstrated a moderate reduction (15-20%) of cardiac output and a decrease of peripheral resistance. During long-term therapy, cardiac output tends to return to control values while peripheral resistance remains decreased. The co-administration of a diuretic enhances antihypertensive efficacy of clonidine.
Blood pressure declines within 30-60 min after an oral clonidine dose.
Pharmacokinetics: The peak plasma clonidine level occurs approximately 3-5 hrs after oral dosing, the plasma half-life (t½) is 12-16 hrs and the elimination t½ is 6-24 hrs. About 50% of the absorbed dose is metabolized in the liver. The t½ increases up to 41 hrs in patients with impaired renal function. About 40-60% of the absorbed dose is recovered in the urine as unchanged drug in 24 hrs.
MedsGo Class
Features
- Clonidine