Clonidine is a medication that was originally used to treat hypertension and now has a number of other medicinal uses. Catapres is an immediate-release form of clonidine that is typically used to treat hypertension but has also been shown to be useful in helping individuals who are withdrawing from alcohol or opioid drugs. It appears to be able to control some of the withdrawal symptoms and cravings associated with discontinuing these drugs. Kapvay (extended-release clonidine) has recently been approved in the treatment of attention deficit hyperactivity disorder (ADHD) when used in conjunction with stimulant medications to treat ADHD, such as Adderall, Ritalin, or Concerta.
Clonidine is also used for a number of other purposes that include:
- To reduce cramping during the menstrual cycle in women
- To treat tics that occur with Tourette’s syndrome
- As an aid to quitting smoking
- To treat chronic or acute pain in some individuals
- As a possible diagnostic aide for a condition known as pheochromocytoma, which is a tumor that develops on a gland near the kidneys
The Addictive Potential of Clonidine
Clonidine is not considered to be a major drug of abuse; however, it does have the potential to be abused.
For some individuals, clonidine may be an attractive drug of abuse for the following reasons:
- It is relatively easy to acquire compared to other drugs that are abused.
- It is inexpensive compared to other drugs that are often abused.
- The awareness of its abuse potential is limited even among physicians.
- It may enhance the effects of other drugs of abuse when taken in conjunction with them.
There are a number of case studies that have documented abuse of clonidine.
- A series of case studies presented in the American Journal of Psychiatry in 1983 outline four studies of individuals who had abused clonidine either by itself or with Valium (diazepam).
- A 1998 study in the Journal of Substance Abuse Treatment documented abuse of clonidine in individuals using methadone.
- A 2001 study in the journal Psychiatric Quarterly documented abuse of clonidine in conjunction with opiate drugs as a method of enhancing the effects of opiates and reducing the amount of the opiate needed to achieve the desired effects.
Clonidine use alone may produce mild euphoric effects; however, these are not the stimulant effects produced by other medications used to treat ADHD, such as Ritalin (methylphenidate). It also appears that there is a documented withdrawal syndrome associated with clonidine abuse that consists of primarily psychological symptoms but also includes issues with cardiovascular effects.
These withdrawal symptoms may include:
- Nervousness and anxiety
- Difficulty concentrating
- Increased heart rate and blood pressure
Signs of Clonidine Abuse
Based on the diagnostic criteria for substance use disorder specified by the American Psychiatric Association (APA), an individual abusing clonidine would demonstrate some of the following:
- Frequently using more clonidine than one had originally planned to use
- Knowing that use of clonidine is resulting in issues with health or emotional functioning but continuing to use it anyway
- Having frequent strong cravings to use clonidine
- Using the drug in situations where it may be dangerous, such as combining it with other drugs, while driving a car, etc.
- Continuing to use clonidine in spite of experiencing problems at work, at school, in relationships, or other issues as a result of using the drug
- Developing tolerance to clonidine
- Giving up important activities as a result of clonidine use
- Developing withdrawal symptoms when one stops using clonidine
- Failing to meet major role obligations as a result of use of the drug
- Frequently using clonidine to avoid withdrawal symptoms
Individuals who have developed a substance use disorder will require formal treatment that will initially consist of a physician-assisted withdrawal management program followed by substance use disorder therapy, support group participation, and continued participation in long-term aftercare programs. The withdrawal management program will typically consist of placing an individual on other medications to control withdrawal symptoms. It may consist of a tapering program where the dosage of clonidine is reduced at specific intervals to allow the individual to be weaned off the drug while not experiencing any significant withdrawal symptoms.
Other Specific Issues and Dangers Associated with Clonidine Use
All drugs have side effect profiles. Clonidine is generally considered safe to use, but there are some side effects that can be associated with its use.
- General feelings of weakness, fatigue, dry mouth, nervousness, and headache
- Nausea, vomiting, and/or constipation
- Symptoms similar to having a cold, such as headache, runny nose, sore throat, congestion, etc.
- Issues with sexual functioning
- Allergic reactions that can include:
- The development of a rash or hives
- Difficulty breathing or swallowing
- Swelling in the face, tongue, lips, eyes, throat, hands, ankles, feet, or lower legs
- Becoming very hoarse
Signs of an allergic reaction should be addressed immediately by discontinuing the medication and going to an emergency department or calling the prescribing physician.
Individuals who take too much clonidine may suffer potential overdose effects that can include:
- Extreme lethargy, drowsiness, and weakness
- Slurred speech
- Extreme fatigue
- Severe confusion or hallucinations
- Significantly decreased heart rate
- Chills, feeling cold, or having cold, pale skin
- Difficulty breathing
- Fainting spells or unconsciousness
- Pinpoint pupils
Individuals who have overdosed on clonidine should receive immediate medical attention. Issues occurring with respiratory suppression can be potentially serious and even fatal. Treatment for overdose typically consists of IV fluids, reversing respiratory suppression, and administering the opiate antagonist naloxone intravenously.
Finally, as with all drugs, there are some untoward interactions that can occur when one uses clonidine in conjunction with other drugs. Using other medications, such as antidepressants, sleep aids, narcotic pain medications, muscle relaxers, anti-anxiety medications, or other medications for hypertension like beta blockers, can result in adverse interactions in some individuals who are also using clonidine. For these reasons, it is strongly recommended that individuals only use clonidine according to its prescribed purposes and under the supervision of a physician. Using clonidine for nonmedicinal reasons and/or without being under the supervision of a physician can result in a number of potentially dangerous consequences.
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