Clonidine

[kchan99]

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I'm wondering if anyone has any views on clonidine for nicotine withdrawal. (I'm not in med school yet, but I'm hoping to start in the fall. I'm on a couple of waiting lists.)

I worked in the office of an orthopedic surgeon who prescribed clonidine patches, starting a week before surgery, for a 40-something year old female patient smoking half a pack a day. She had tried hypnosis, counseling, and nicotine patches & gum, all of which did not work for her. She was on bupropion. In addition, she was taking MSContin.

The surgeon did an anterior-posterior spinal fusion (posterior laminectomy and fusion of the vertebral bodies) for spinal stenosis and severe spondylolisthesis. The patient understood that she had to have such an enormous procedure because her smoking would be detrimental to bone growth and decrease the chance of good fusion. She wanted to quit smoking in hopes of a speedy recovery.

I talked to the patient two days before she started using the clonidine patch. She was was crying a lot and sounded quite anxious about the surgery. (The surgeon didn't really want to talk to her, but he phoned in a precription for the patches.) Two days later, the patient sounded much calmer. Is clonidine that anxiolytic?

Some time after the surgery, she would have to be weaned off the morphine. How would clonidine affect that?

Thanks for any insight.

 

[OldPsychDoc]

I'm wondering if anyone has any views on clonidine for nicotine withdrawal. (I'm not in med school yet, but I'm hoping to start in the fall. I'm on a couple of waiting lists.)
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I talked to the patient two days before she started using the clonidine patch. She was was crying a lot and sounded quite anxious about the surgery. (The surgeon didn't really want to talk to her, but he phoned in a precription for the patches.) Two days later, the patient sounded much calmer. Is clonidine that anxiolytic?

Some time after the surgery, she would have to be weaned off the morphine. How would clonidine affect that?

Thanks for any insight.

As far as anxiolysis, your talking to her probably was as important as the med, but it can calm folks down. You'll especially see it used to quiet hyperactive kids in child psych. I've not used it for nicotine withdrawal, but it is very often used in opioid withdrawal, usually as a 3-6 day taper in detox, so you may see it when she's coming off the ms-contin too.

 

[Anasazi23]

As far as anxiolysis, your talking to her probably was as important as the med, but it can calm folks down. You'll especially see it used to quiet hyperactive kids in child psych. I've not used it for nicotine withdrawal, but it is very often used in opioid withdrawal, usually as a 3-6 day taper in detox, so you may see it when she's coming off the ms-contin too.

Agreed. Although I also tend to use it more in hypersympathetic arousal cases, either in detox or in the ICU. Nicotine withdrawal is generally handled through nicotine patches and gum in my hospital, and seems to work fine. I would be reluctant to use clonidine on an outpatient basis, as I see more and more attendings becoming disillusioned with the rebound hypertensive episodes.

 

[blick]

Anyone know the mechanism of action? How can a centrally acting antihypertensive agent be anxiolytic? Thanks!