RiteMED Clonidine Special Precautions

Clonidine withdrawal: Instruct patients not to discontinue clonidine therapy without consulting a physician. Abrupt withdrawal of clonidine treatment may result in symptoms such as nervousness, agitation, headache, and tremor followed by a rapid increase in blood pressure and an increase in plasma catecholamine concentration. Such occurrences have usually been associated with previous administration of high oral doses (exceeding 1200 mcg/day) or with continuation of concomitant beta-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 to 4 days to avoid withdrawal symptoms.
If clonidine therapy is to be discontinued in patients receiving clonidine and a beta-blocker concomitantly, the beta-blocker should be discontinued several days before clonidine therapy is discontinued.
Because children commonly have gastrointestinal illnesses that lead to vomiting, they may be particularly susceptible to hypertensive episodes resulting from abrupt inability to take medication.
Perioperative use: It is recommended that clonidine therapy not be interrupted for surgery; transdermal therapy may be continued throughout the perioperative period and oral therapy should be continued to within 4 hours before surgery. Blood pressure should be monitored carefully during surgery and additional measures to control blood pressure should be available if required. If clonidine therapy must be interrupted for surgery, parenteral antihypertensive therapy should be administered as necessary, and clonidine must be resumed as soon as possible.
Use with caution in patients with severe coronary insufficiency, recent myocardial infarction, conduction disturbances, mild to moderate bradyarrhythmia (e.g., slow sinus rhythm), cerebrovascular disease, disorders of cerebral or peripheral perfusion, polyneuropathy, depression, chronic renal failure, Raynaud's disease, thromboangiitis obliterans, or constipation.
As with other antihypertensive drugs, clonidine treatment should be monitored particularly carefully in patients with heart failure or severe coronary disease.
No therapeutic effect of clonidine may be expected in hypertension caused by pheochromocytoma.
The possibility that clonidine may lower blood pressure in patients receiving the drug for conditions other than hypertension (e.g., smoking cessation, pain management, attention deficit hyperactivity disorder) should be considered and blood pressure should be monitored as appropriate.
Patients with a history of mental depression require careful supervision while receiving clonidine as they may be subject to further depressive episodes.
Patients who engage in potentially hazardous activities such as operating machinery or driving should be warned of a possible sedative effect of clonidine. Patients should also be informed that this sedative effect may be increased by concomitant use of CNS depressants such as opiate agonists or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol (see Interactions).
In patients who have developed localized skin reaction to transdermal clonidine, substitution of oral clonidine may be associated with the development of a generalized rash.
Patients who wear contact lenses should be warned that clonidine treatment may cause decreased lacrimation and dryness of the eyes.
When clonidine is used off-label concomitantly with methylphenidate in children with attention-deficit hyperactivity disorder (ADHD), serious adverse reactions including death have been observed.
Use in Children: The safety and efficacy of clonidine in children and adolescents have not been established.