clonidine hydrochloride: clinical use

Prescribing considerations

• Confirm the exact formulation, concentration and licensed indication.
• Avoid abrupt withdrawal because rebound hypertension and sympathetic symptoms may occur.
• Use particular care in renal impairment; response is variable and routine haemodialysis removes little clonidine.
• Review fall and driving risk with sedation or postural hypotension.
• Injection requires hospital administration and haemodynamic observation.

Contraindications and cautions

• Hypersensitivity to clonidine or a formulation component.
• Severe bradyarrhythmia associated with sick sinus syndrome or second- or third-degree atrioventricular block.
• Check product-specific excipients and contraindications.

Monitoring

• Blood pressure and symptoms of postural hypotension.
• Pulse and cardiac conduction where clinically indicated.
• Renal function and clinical response in renal impairment.
• Mood in people with current or previous depression.
• Constipation, sedation, dry eyes and other treatment-limiting effects.

Clinical pharmacology

A centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow and increases vagal tone. Renal elimination is clinically important; effects include reduced heart rate and vascular resistance.

Formulation and product differences

• Selected tablets and lower-concentration oral solution are licensed for migraine prevention and menopausal flushing.
• The selected higher-concentration oral solution is licensed for hypertension.
• Injection is licensed for hypertensive crises and administered by healthcare professionals.
• Oral solutions differ in concentration, measuring devices and excipients and are not necessarily interchangeable volume-for-volume.

Oral solution

Route: Oral

Strengths: 50 micrograms/5 mL, 100 micrograms/5 mL

Tablet

Route: Oral

Strengths: 25 micrograms

Injection

Route: Parenteral

Strengths: 150 micrograms/mL