Nurses Compass
Drug Guide
Clonidine
Classification
Therapeutic: Antihypertensive, central alpha-2 adrenergic agonist
Pharmacological: Alpha-2 adrenergic agonist
FDA Approved Indications
- Hypertension
- ADHD (attention deficit hyperactivity disorder)
- Scheduled opioid withdrawal
Mechanism of Action
Clonidine stimulates alpha-2 adrenergic receptors in the brainstem, reducing sympathetic outflow from the central nervous system, which decreases peripheral vascular resistance, heart rate, and blood pressure.
Dosage and Administration
Adult: For hypertension: typically 0.1 mg twice daily, titrated as needed. Transdermal patches: 0.1 to 0.3 mg/24 hours applied once weekly.
Pediatric: For ADHD: 0.1 mg orally twice daily, titrated as needed. Transdermal patches: 0.1 mg/24 hours applied once weekly.
Geriatric: Start at lower doses due to increased sensitivity; closely monitor response.
Renal Impairment: Use with caution; dosage adjustments may be necessary.
Hepatic Impairment: No specific adjustment; use cautiously.
Pharmacokinetics
Absorption: Well absorbed orally; transdermal absorption is steady over 24 hours.
Distribution: Widely distributed; crosses blood-brain barrier.
Metabolism: Partially hepatic metabolism.
Excretion: Renal excretion of unchanged drug and metabolites.
Half Life: 12-16 hours.
Contraindications
- Known hypersensitivity to clonidine or components.
- Use with caution in patients with a history of heart disease, cerebrovascular disease, or recent myocardial infarction.
Precautions
- Monitor blood pressure closely during titration.
- Potential for rebound hypertension if discontinued abruptly.
- Use caution in pregnancy and breastfeeding; benefits and risks should be evaluated.
Adverse Reactions - Common
- Dry mouth (Common)
- Drowsiness (Common)
- Dizziness (Common)
- Fatigue (Common)
Adverse Reactions - Serious
- Hypotension (Serious)
- Rebound hypertension upon abrupt discontinuation (Serious)
- Bradycardia (Serious)
- Sedation or somnolence (Serious)
Drug-Drug Interactions
- Beta blockers (additive bradycardia effect)
- Other antihypertensives (potentiation)
- CNS depressants (enhanced sedation)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure and heart rate regularly; assess for signs of orthostatic hypotension.
Diagnoses:
- Risk for falls related to dizziness or hypotension.
- Ineffective peripheral tissue perfusion due to hypotension.
Implementation: Ensure correct dosing especially during titration; educate patient on the importance of adherence; advise against abrupt discontinuation.
Evaluation: Regular monitoring of blood pressure to assess therapeutic effectiveness.
Patient/Family Teaching
- Take medication exactly as prescribed; do not stop suddenly.
- Notify healthcare provider if experiencing dizziness, fainting, or rapid heartbeat.
- Avoid alcohol and CNS depressants unless approved.
- Report any signs of allergic reactions or severe side effects.
Special Considerations
Black Box Warnings:
- Rebound hypertension can occur if medication is suddenly discontinued; taper gradually.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: May affect certain laboratory tests, including serum glucose levels.
Overdose Management
Signs/Symptoms: Hypotension, bradycardia, sedation, respiratory depression in severe cases.
Treatment: Supportive care, gastric lavage if ingestion is recent, activated charcoal, vasopressors for hypotension, atropine for bradycardia.
Storage and Handling
Storage: Store at room temperature away from moisture and heat.
Stability: Stable until expiration date on package.