Clonidine Withdrawal

Anyone know of a recommended regimen for tapering a patient off of clonidine to avoid rebound hypertension? What if the patient is also on metoprolol 50mg qd and enalapril 5mg qd? I have read that a patient should be tapered off the beta blocker a few days prior to starting to taper the clonidine but what should be done in the meantime to control the hypertension, increase the enalapril?

Appreciate any input, thanks!

nikkai said:

Ah tapering, the area where most students (and some practitioners) so desperately seek a set regimen. Thing is, it will differ with practically every patient. Before you jump straight into looking for a percentage this day, a dash off that day, you gotta consider a myriad of other factors along with just the drugs. For example

Cloni-izo strength?
Formulation of said cloni-shizzo?
Length of time on said cloni-dizo?
Age of pt
Weight/BMI of pt
Overall cardiac function
Other meds
Other conditions
Admitted or out-and-about
How compliant they actually gonna be on the regimen if you taper.
etc.

You could tell us what you THINK you would do, and we could give you some input.

Click to expand...

Thanks for the reply, kinda suprised I got one since no one seems to know about this. Some more info: Patient has been on PO clonidine for the last 10 years until recently when she couldn't take the sedation any more and was switched to 0.1 transdermal. The patch helped a lot but unfortunately her insurance stopped covering it and is now paying out of pocket. She doesn't want to go back to PO clonidine.

Patient is in her 50s, ambulatory, in good health other than being overweight (maybe ~30 lbs). No known cardio problems, no compliance issues, BP has been around 110/70 for a few years. As I said in the previous post, pt is also on metoprolol 50mg qd and enalapril 5mg qd.

My idea was to slowly taper metoprolol over one week as tolerated and then slowly taper clonidine over 2 weeks as tolerated.

Would increasing enalapril and possibly adding an alpha/beta blocker help? Or maybe keeping metoprolol and adding an alpha blocker for the duration of the withdrawal.

I would really appreciate any info as to if this is in the right direction. Thanks in advance!

WVUPharm2007 said:

You could try that fancy-smancy Bystolic junk. It's a beta blocker/vasodialator.

Really, it's something I'm not sure there are definitive guidelines on. Perhaps something like....take the patch off...start clonidine 0.1 po BID...then taper to qd...then d/c and see what happens?

Click to expand...

Thanks, was thinking of something along these lines. One concern is the control of the BP after the clonidine is gone. Any experience with the need to increase any of the other BP meds to compensate for the d/c'd clonidine or just play it by ear?