In this article, I wanted to share information on tapering clonidine. This drug can cause serious rebound hypertension when abruptly discontinued and patients may not understand or realize that this risk exists. Here’s a case scenario that demonstrates tapering clonidine.
JS is a 52-year-old female who has a history of resistant hypertension. She was doing some research on the internet and felt that her dry mouth was being caused by clonidine. It was so bothersome that she elected to discontinue her 0.3 mg BID dosing on her own.
She was monitoring her blood pressure daily and her systolic typically ran between 130-150 mmHg. Within a few days of discontinuing her clonidine, her blood pressure spiked to greater than 180 mmHg. She became panicked about her elevated blood pressure and went to the clinic to see her primary provider. Upon questioning, it was discovered that she quit the clonidine due to the fact that she felt it was causing adverse effects.
Tapering clonidine can help prevent rebound hypertension, but how slowly do we need to go? According to the package insert for the extended-release product, “When discontinuing, taper the dose in decrements of no more than 0.1 mg every 3 to 7 days to avoid rebound hypertension.” Uptodate has a recommendation to target at least a period of 6-10 days with a dose reduction of 1/3 to 1/2 every 2-3 days.
Being conservative is the way I like to lean in cases where the adverse effect isn’t likely to cause serious long-term issues. JS should have tapered clonidine over a period of at least 1-2 weeks given the higher dose that she was taking and I would probably recommend in the range of 2-4 weeks or longer to be safe if the patient was willing. She had stopped taking the clonidine for about 3 days when she went to the clinic. The primary provided elected to restart the clonidine at 0.1 mg BID with the goal of reviewing if the dry mouth continued to be an issue after 3-5 days of clonidine at a lower dose.
Hopefully, this provides some insight into tapering clonidine. I always prefer the conservative side of dose reductions to avoid withdrawal symptoms, but that needs to be weighed with the risk of continuing or adverse effect(s) that the drug is potentially causing. Interested in more on clonidine and the alpha-2 agonists? Here’s a previous post comparing agents in this class.
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