Drugs List

Therapeutic Indications

Uses

Hypertension

Contraindications

Children under 2 years
Breastfeeding
Galactosaemia
Severe bradycardia due to AV block (2nd/3rd degree)
Severe bradycardia due to sinus node dysfunction

Precautions and Warnings

Children aged 2 to 18 years
Constipation
Wearing of contact lenses
Bradycardia
Cardiac failure
Cardiac impairment
Cerebrovascular insufficiency
Depression
Glucose-galactose malabsorption syndrome
History of depression
Ischaemic heart disease
Lactose intolerance
Occlusive peripheral vascular disorder
Polyneuropathy
Pregnancy
Renal impairment

Not suitable for hypertension secondary to phaeochromocytoma
Advise ability to drive/operate machinery may be affected by side effects
Contains lactose
Stop betablocker several days before clonidine if withdrawing combination
Monitor patients with cardiac failure
Do not withdraw this drug suddenly
Advise patient not to take NSAIDs unless advised by clinician
Advise patient to moderate alcohol intake during treatment
Advise contact lens wearers of possibility of reduced lacrimation
Advise patient on possible rebound phenomena on withdrawal

Patients undergoing anaesthesia should continue their clonidine treatment before, during and after anaesthesia using oral or i.v. administration according to individual circumstances.

Pregnancy and Lactation

Pregnancy

If clonidine is used during pregnancy it is recommended that the mother and child are monitored. Clonidine passes the placental barrier and may lower the heart rate of the foetus. Post partum a transient rise in blood pressure in the newborn cannot be excluded. There are no data on the long-term effects of pre-natal exposure. Schaeffer (2007) considered clonidine to be a second line choice for treatment of hypertension during pregnancy. Its use is not an indication for termination of the pregnancy or for invasive diagnostic procedures.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Contraindicated in breastfeeding due to inadequate evidence of safety. Clonidine is secreted into the breast milk. Schaeffer (2007) states that clonidine at the usual maternal doses used for hypertension reaches near therapeutic levels in the breastfed infant, although no adverse effects have been reported. It is recommended that clonidine is not used during breastfeeding, but if already started, weaning is not necessary but the maternal therapy should be changed to a preferred drug for the indication.

Clonidine has complex dose related actions in prolactin secretion which may affect lactation.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abnormal liver function tests
Alopecia
Atrioventricular block
Bradyarrhythmias
Confusion
Constipation
Decreased lacrimation
Delusions
Depression
Disturbances in accommodation
Dizziness
Drowsiness
Dry mouth
Dryness and irritation of eyes
Dryness of nasal mucosa
Elevated blood glucose (transient)
Fatigue
Fluid retention
Gynaecomastia
Hallucinations
Headache
Hepatitis
Impotence
Malaise
Nausea
Nightmares
Orthostatic hypotension
Pain in parotid gland
Paraesthesia
Pruritus
Pseudo-obstruction of the large intestine
Rash
Raynaud's phenomenon
Reduced libido
Sedation
Sinus bradycardia
Sleep disturbances
Urticaria
Vomiting

Presentation

High strength formulation of clonidine hydrochloride.

Drugs List

Therapeutic Indications

Uses

Hypertension

Dosage

Adults

Children

Patients with Renal Impairment

Additional Dosage Information

Contraindications

Children under 2 years
Breastfeeding
Galactosaemia
Severe bradycardia due to AV block (2nd/3rd degree)
Severe bradycardia due to sinus node dysfunction

Precautions and Warnings

Children aged 2 to 18 years
Constipation
Wearing of contact lenses
Bradycardia
Cardiac failure
Cardiac impairment
Cerebrovascular insufficiency
Depression
Glucose-galactose malabsorption syndrome
History of depression
Ischaemic heart disease
Lactose intolerance
Occlusive peripheral vascular disorder
Polyneuropathy
Pregnancy
Renal impairment

Not suitable for hypertension secondary to phaeochromocytoma
Advise ability to drive/operate machinery may be affected by side effects
Contains lactose
Stop betablocker several days before clonidine if withdrawing combination
Monitor patients with cardiac failure
Do not withdraw this drug suddenly
Advise patient not to take NSAIDs unless advised by clinician
Advise patient to moderate alcohol intake during treatment
Advise contact lens wearers of possibility of reduced lacrimation
Advise patient on possible rebound phenomena on withdrawal

Patients undergoing anaesthesia should continue their clonidine treatment before, during and after anaesthesia using oral or i.v. administration according to individual circumstances.

Pregnancy and Lactation

Pregnancy

If clonidine is used during pregnancy it is recommended that the mother and child are monitored. Clonidine passes the placental barrier and may lower the heart rate of the foetus. Post partum a transient rise in blood pressure in the newborn cannot be excluded. There are no data on the long-term effects of pre-natal exposure. Schaeffer (2007) considered clonidine to be a second line choice for treatment of hypertension during pregnancy. Its use is not an indication for termination of the pregnancy or for invasive diagnostic procedures.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Contraindicated in breastfeeding due to inadequate evidence of safety. Clonidine is secreted into the breast milk. Schaeffer (2007) states that clonidine at the usual maternal doses used for hypertension reaches near therapeutic levels in the breastfed infant, although no adverse effects have been reported. It is recommended that clonidine is not used during breastfeeding, but if already started, weaning is not necessary but the maternal therapy should be changed to a preferred drug for the indication.

Clonidine has complex dose related actions in prolactin secretion which may affect lactation.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abnormal liver function tests
Alopecia
Atrioventricular block
Bradyarrhythmias
Confusion
Constipation
Decreased lacrimation
Delusions
Depression
Disturbances in accommodation
Dizziness
Drowsiness
Dry mouth
Dryness and irritation of eyes
Dryness of nasal mucosa
Elevated blood glucose (transient)
Fatigue
Fluid retention
Gynaecomastia
Hallucinations
Headache
Hepatitis
Impotence
Malaise
Nausea
Nightmares
Orthostatic hypotension
Pain in parotid gland
Paraesthesia
Pruritus
Pseudo-obstruction of the large intestine
Rash
Raynaud's phenomenon
Reduced libido
Sedation
Sinus bradycardia
Sleep disturbances
Urticaria
Vomiting

Withdrawal Symptoms and Signs

Sudden withdrawal from treatment, especially those who have been receiving high doses may result in:
Rebound hypertension
Restlessness
Palpitations
Nervousness
Tremor
Headache
Abdominal symptoms
Agitation

If these symptoms occur, they can usually be treated with reintroduction of clonidine or with alpha and beta blocking agents.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2013

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

Summary of Product Characteristics: Catapres Tablets 100 micrograms. Boehringer Ingelheim Ltd. Revised July 2014.

The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, A. Radcliffe Medical Press, Abingdon.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Clonidine Last revised: April 3, 2012
Last accessed: May 16, 2013

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 17 August 2017