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clonidine

Pronunciation

Generic Name: clonidine (transdermal) (KLOE ni deen)
Brand Name: Catapres-TTS-1, Catapres-TTS-2, Catapres-TTS-3

What is clonidine transdermal?

Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily.

Clonidine transdermal (skin patch) is used to treat hypertension (high blood pressure). It is sometimes used together with other blood pressure medications.

Clonidine transdermal may also be used for purposes not listed in this medication guide.

What is the most important information I should know about clonidine transdermal?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

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What should I discuss with my healthcare provider before using clonidine transdermal?

You should not use this medicine if you are allergic to clonidine.

To make sure clonidine transdermal is safe for you, tell your doctor if you have:

  • heart disease or severe coronary artery disease;

  • a heart rhythm disorder;

  • history of heart attack or stroke;

  • pheochromocytoma (tumor of the adrenal gland);

  • kidney disease; or

  • if you have ever had an allergic reaction to clonidine transdermal.

FDA pregnancy category C. It is not known whether clonidine transdermal is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Clonidine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use clonidine transdermal?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

This medicine comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Wash your hands with soap and water before and after applying a skin patch. Also wash the skin area where the patch is worn. Rinse and wipe dry with a clean tissue.

Apply the skin patch to a flat, hairless area of the chest, back, side, or outer side of your upper arm. To remove any hair from these areas, clip the hair short but do not shave it. Press the patch firmly with the palm making sure it sticks, especially around the edges.

Remove the skin patch after 7 days and replace it with a new one. Choose a different place on your skin to wear the patch each time you put on a new one. Do not use the same skin area 2 weeks in a row.

Do not wear more than 1 patch at a time unless your doctor has told you to.

Clonidine skin patches come with optional "cover" patches. The cover patch is placed over the clonidine patch to help it stick to your skin. The clonidine patch is square and the cover patch is round. The cover patch does not contain any active medicine. It should be worn only over a clonidine patch.

You may use a cover patch if the clonidine patch becomes loose or falls off before you have worn it for 7 days. Apply the cover patch over the clonidine patch. Keep both patches on for the rest of your 7-day wearing time.

After removing a skin patch fold it in half, sticky side in, and throw it away where children and pets cannot get to it.

The clonidine transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the clonidine patch before undergoing such a test.

Tell any doctor or other healthcare provider who treats you that you are using clonidine transdermal. If you need emergency heart resuscitation, your family or caregivers should tell emergency medical personnel if you are wearing a clonidine skin patch. The patch should be removed before any electrical equipment (such as a defibrillator) is used on you.

Do not stop using clonidine transdermal suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture and heat. Keep each skin patch in the foil pouch until you are ready to use it.

What happens if I miss a dose?

Apply a skin patch as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra patches to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath) followed by low blood pressure (feeling light-headed, fainting, drowsiness, cold feeling, slow heart rate, shallow breathing, weakness, or pinpoint pupils).

What should I avoid while using clonidine transdermal?

Avoid using lotions, oils, or other skin products on the area where you will apply the skin patch. The patch may not stick properly to the skin.

Drinking alcohol can increase certain side effects of clonidine transdermal.

Clonidine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Clonidine transdermal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • fast or pounding heartbeats;

  • a very slow heart rate (fewer than 60 beats per minute);

  • shortness of breath (even with mild exertion), swelling, rapid weight gain;

  • confusion, hallucinations;

  • fever, pale skin;

  • little or no urinating;

  • numbness or cold feeling in your hands or feet;

  • a light-headed feeling, like you might pass out; or

  • severe skin irritation, swelling, burning, or blistering where the patch is worn.

Common side effects may include:

  • dizziness, drowsiness, tired feeling;

  • dry mouth;

  • headache;

  • lack of energy; or

  • skin discoloration or mild irritation where the patch is worn.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Clonidine dosing information

Usual Adult Dose for Hypertension:

Initial dose (PO): 0.1 mg orally twice a day (morning and bedtime).
Maintenance dose: 0.2 to 0.6 mg/day given in divided doses.

Initial dose (patches):Clonidine TTS-1 (0.1 mg/24 hr) applied once a week.
Maintenance dose: If after 1 to 2 weeks the desired reduction in blood pressure is not achieved, increase the dosage by adding another TTS-1 film or changing to a larger system.
An increase in dosage above 2 clonidine TTS-3 films is usually not associated with additional efficacy.

Extended-release tablets:
Initial dose: 0.17 mg orally once daily at bedtime. Further increments of 0.09 mg orally once daily may be made at weekly intervals if necessary until the desired response is achieved.
Maintenance dose: 0.17 mg to 0.52 mg orally once daily at bedtime

Extended-release oral suspension:
Initial dose: 0.17 mg (2 mL) orally once daily at bedtime. Further increments of 0.09 mg (1 mL) orally once daily may be made at weekly intervals if necessary until the desired response is achieved.
Maintenance dose: 0.17 mg to 0.52 mg orally once daily at bedtime

Usual Adult Dose for Pain:

Continuous Epidural Infusion:
Initial dose: 30 mcg/hr.
May be titrated up or down depending on pain relief and occurrence of adverse events.
Maximum dose 40 mcg/hr.

Usual Adult Dose for Pheochromocytoma Diagnosis:

0.3 mg orally once. Clonidine is only recommended after baseline determination of plasma catecholamines. Two baseline samples can be obtained five minutes apart from an existing IV line after the patient has remained supine for 90 minutes (a new needle stick could increase catecholamine concentrations and foul the test).

After the initial dose of clonidine, three additional hourly blood samples may be obtained for plasma catecholamine concentration measurements.

Generally, patients with hypertension and pheochromocytoma do NOT show a decrease in plasma catecholamine levels after this "suppression test", whereas hypertensive patients without pheochromocytoma do. False negative tests have been reported.

Usual Adult Dose for Hypertensive Emergency:

0.2 mg orally once. Additional doses of 0.1 mg may be given as needed and tolerated every hour to control this patient's blood pressure. Be cognizant of the risk of stroke or heart attack or other problem associated with aggressive blood pressure reduction, especially in older persons. The maximum recommended total daily dose in any case of emergent hypertension is 0.8 mg.

Some clinicians report a poor antihypertensive effect of clonidine in patients with spinal injuries since this drug acts on the central nervous system to inhibit peripheral sympathetic tone, and the central and peripheral nervous systems are disrupted in these patients.

Usual Adult Dose for Alcohol Withdrawal:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Anxiety:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Benzodiazepine Withdrawal:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Migraine Prophylaxis:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Perimenopausal Symptoms:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Smoking Cessation:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Bipolar Disorder:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Opiate Withdrawal:

0.2 mg orally twice a day or TTS-2 (0.2 mg) transdermal patch once a week.

Usual Pediatric Dose for Attention Deficit Disorder:

May be used alone or as an adjunct to stimulants.

Immediate release (unlabeled indication):
Children less than or equal to 45 kg:
Initial dose: 0.05 mg orally at bedtime. Increase sequentially every 3 to 7 days by 0.05 mg increments as 2 times daily, then 3 times daily, then 4 times daily.
Maximum dose: 0.2 mg/day orally for patients weighing 27 to 40.5 kg; 0.3 mg/day for patients weighing 40.5 to 45 kg.
When discontinuing therapy, taper gradually over 1 to 2 weeks.

Children greater than 45 kg:
Initial dose: 0.1 mg orally at bedtime. Increase sequentially every 3 to 7 days by 0.1 mg increments as 2 times daily, then 3 times daily, then 4 times daily
Maximum dose: 0.4 mg/day
When discontinuing therapy, taper gradually over 1 to 2 weeks.

Extended release (Kapva {R}):
Children greater than or equal to 6 years:
Initial dose: 0.1 mg orally at bedtime. Increase in 0.1 mg/day increments every 7 days until desired response. Doses should be administered twice daily (either split equally or with the higher split dosage given at bedtime).
Maximum dose: 0.4 mg/day orally
Note: Maintenance treatment for greater than 5 weeks has not been evaluated.
When discontinuing therapy, taper daily dose by less than or equal to 0.1 mg every 3 to 7 days.
Transdermal: Children may be switched to the transdermal delivery system after oral therapy is titrated to an optimal and stable dose; a transdermal dose approximately equivalent to the total oral daily dose may be used.

The dose of clonidine extended-release tablets, administered either as monotherapy or as adjunctive therapy to a psychostimulant, should be individualized according to the therapeutic needs and response of the patient. Dosing should be initiated with one 0.1 mg tablet at bedtime, and the daily dosage should be adjusted in increments of 0.1 mg/day at weekly intervals until the desired response is achieved. Doses should be taken twice a day, with either an equal or higher split dosage being given at bedtime.

What other drugs will affect clonidine transdermal?

Using this medicine with other drugs that make you sleepy or lower your blood pressure can worsen these effects. Ask your doctor before using clonidine transdermal with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with clonidine transdermal, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about clonidine transdermal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 7.02. Revision Date: 2014-02-05, 8:25:41 AM.

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