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clonidine (Epidural route)

Pronunciation

KLOE-ni-deen

Epidural route(Solution)

The 500-mcg/mL strength product should be diluted prior to use in an appropriate solution. Epidural clonidine is not recommended for obstetrical, postpartum, or perioperative pain management. The risk of hemodynamic instability, especially hypotension and bradycardia, from epidural clonidine may be unacceptable in these patients. However, in a rare obstetrical, postpartum or perioperative patient, potential benefits may outweigh the possible risks .

Commonly used brand name(s)

In the U.S.

  • Duraclon

Available Dosage Forms:

  • Solution
  • Injectable

Therapeutic Class: Analgesic

Pharmacologic Class: Alpha-2 Adrenergic Agonist

Uses For clonidine

Clonidine injection is used with injected pain medicine to treat pain in cancer patients.

Clonidine is to be started under the immediate supervision of your doctor. After your doctor has seen how you respond to clonidine, you may be able to receive clonidine at home.

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clonidine is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, clonidine is used in certain patients with the following medical conditions:

  • Post-operative shivering (to prevent or treat shivering that occurs after an operation or anesthesia)

Before Using clonidine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For clonidine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to clonidine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Although there is no specific information comparing use of clonidine in children with use in other age groups, clonidine is not expected to cause different side effects or problems in children than it does in adults. clonidine is usually used in children only when the pain is severe and other pain medicines did not help.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of clonidine in the elderly with use in other age groups.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies suggest that this medication may alter milk production or composition. If an alternative to this medication is not prescribed, you should monitor the infant for side effects and adequate milk intake.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking clonidine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using clonidine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amifampridine

Using clonidine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Amitriptyline
  • Amoxapine
  • Atenolol
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Carteolol
  • Celiprolol
  • Clomipramine
  • Crizotinib
  • Desipramine
  • Dilevalol
  • Diltiazem
  • Dothiepin
  • Doxepin
  • Esmolol
  • Imipramine
  • Levobunolol
  • Lofepramine
  • Metipranolol
  • Metoprolol
  • Mirtazapine
  • Nadolol
  • Nebivolol
  • Nortriptyline
  • Oxprenolol
  • Penbutolol
  • Pindolol
  • Propranolol
  • Protriptyline
  • Sotalol
  • Tertatolol
  • Timolol
  • Trimipramine
  • Verapamil

Using clonidine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Cyclosporine
  • Fluphenazine
  • Mepivacaine
  • Naloxone
  • Yohimbine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of clonidine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Anticoagulant therapy or
  • Bleeding problems—Bleeding into the area around the spinal cord is possible
  • Heart or blood vessel disease—Clonidine may make these conditions worse
  • Infection at the place of injection or catheter (tube)—The risk of developing meningitis or an abscess is increased
  • Kidney disease—Effects of clonidine may be increased because of slower removal of clonidine from the body
  • Pain associated with surgery or
  • Pain during or following childbirth—The ability to tolerate some of the potential side effects of clonidine may be decreased

Proper Use of clonidine

Clonidine is given continuously as an epidural infusion (run around the spinal cord) using an infusion pump. The pump and its tube should be checked regularly to make sure the clonidine flow has not stopped accidentally. The injection or catheter site should also be checked regularly for signs of infection.

If you are using clonidine at home, make sure you understand exactly how to use it.

Dosing

The dose of clonidine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of clonidine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:
    • For pain:
      • Adults—30 mcg per hour given as a continuous infusion.
      • Children—Dosage is based on body weight and must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

Tell your doctor immediately if you think the clonidine has stopped for any reason.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using clonidine

clonidine should not be stopped without the doctor's supervision. Serious side effects may occur if clonidine is stopped suddenly.

clonidine may add to the effects of alcohol and other CNS depressants (medicine that may make you drowsy or less alert). Check with your doctor before taking any such depressants while you are using clonidine.

Dizziness, light-headedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help.

clonidine may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to clonidine before you drive, use machines, or do other jobs that require you to be alert.

clonidine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common
  • Dizziness, light-headedness, or fainting
  • slow heartbeat
Less common
  • Chest pain
  • extremely shallow or slow breathing
  • fast heartbeat
  • fever
  • hallucinations (seeing, feeling, or hearing things that are not there)
  • mental depression
  • sleepiness (excessive)
  • vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Anxiety
  • confusion
  • dry mouth
  • nausea
  • sleepiness
Less common
  • Constipation
  • ringing, buzzing, or other unexplained noises in the ears
  • sweating, unusual
  • weakness

After you stop using clonidine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

  • Agitation
  • headache
  • nervousness
  • pounding heartbeat
  • shaking or trembling

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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