Why Clonidine Should Not Be Stopped Cold Turkey

Zandra asked

I have been on clonidine for anxiety/sleep for about 4 weeks. Doesn't do anything for sleep so the doctor said to stop it. Shouldn't I ween down? For 3 weeks I took 0.1mg and 0.2mg for 1 week. Thank you in advance.

Answer

Yes, clonidine is generally recommended to be slowly tapered before discontinuing. In most cases, it should not be stopped abruptly (i.e. 'cold-turkey').

Why Shouldn't Clonidine Be Stopped Abruptly?

Abrupt discontinuation of clonidine can precipitate a withdrawal syndrome that is often referred to as a 'catecholamine rebound', characterized by an increase in various neurotransmitters, notably norepinephrine.

Per the prescribing information for clonidine:

Patients should be instructed not to discontinue therapy without consulting their physician. Sudden cessation of clonidine treatment has, in some cases, resulted in symptoms such as nervousness, agitation, headache, and tremor accompanied or followed by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma.

Potential symptoms of withdrawal include:

• Rebound hypertension (blood pressure increase)
• Headache
• Restlessness
• Agitation
• Anxiety
• Insomnia
• Sweating
• Tachycardia (increased heart rate)
• Tremors
• Muscle cramps
• Hiccups
• Nausea
• Salivation
• Stroke (rare)

Clonidine Withdrawal Risk Factors

There are certain risk factors that increase the chance of withdrawal symptoms occurring, and these include:

• Abrupt discontinuation
• History of high blood
• Use over one month
• High doses
• Concomitant beta-blocker therapy

Methods For Tapering Clonidine

First and foremost, you should discuss a plan to discontinue clonidine with your doctor. There is no single recommended way to taper clonidine and the method employed will be based on numerous factors, such as your medical history, the doctor's professional judgment, and concomitant medications.

Nevertheless, various sources offer recommendations.

One source recommends to:

• Taper over one to two weeks, decreasing by 0.1 mg every three to seven days.
• During the taper, monitor blood pressure closely.

The prescribing information for Catapres (brand for clonidine) recommends to:

• Reduce the dose gradually over 2 to 4 days to avoid withdrawal symptoms.

As mentioned above, it is important to discuss potential tapering methods that will work for your particular situation with your doctor.