Catapres Tts-1 Weekly Patch
It is used to treat high blood pressure.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihypertensive
Pharmacologic Class
Centrally acting alpha-2 adrenergic agonist
Pregnancy Category
Category C
FDA Approved
Sep 1984
DEA Schedule
Not Controlled
Overview
What is this medicine?
Catapres-TTS is a patch that you stick on your skin once a week to help lower high blood pressure. It works by calming down certain signals in your brain that tell your blood vessels to tighten, which helps them relax and lowers your blood pressure.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. Continue using this medication as directed by your doctor or healthcare provider, even if you feel well.
Applying the Patch
1. Remove the old patch before applying a new one.
2. Wash your hands before and after handling the patch.
3. Do not cut or divide the patches, and do not use damaged patches.
4. Apply the patch to clean, dry, healthy skin on your chest or upper arm. Rotate the site with each new patch to avoid skin irritation.
5. Choose a site without hair and avoid areas with skin folds or skin that may be rubbed by tight clothing.
6. You can bathe, shower, or swim while wearing the patch.
Securing the Patch
The patch comes with a cover to hold it in place if it comes loose. This cover does not contain any medication and should not be used alone. If the patch becomes loose, apply the cover over the patch as directed.
Skin Irritation
If the skin under the patch becomes mildly irritated, you may remove the patch and apply a new one to a different area.
Disposing of Used Patches
After removing a used patch, fold the sticky sides together and dispose of it in a secure location where children and pets cannot access it. This medication can be harmful to children if accidentally ingested or applied, so seek medical help immediately if this occurs.
Stopping the Medication
Do not stop using this medication suddenly without consulting your doctor, as this may increase the risk of side effects. If you need to stop using this medication, your doctor will instruct you on how to gradually discontinue it.
Storing and Disposing of the Medication
Store the medication at room temperature in a dry place, away from bathrooms. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications according to the instructions provided. Do not flush medications down the toilet or pour them down the drain unless instructed to do so. Check with your pharmacist for guidance on disposing of medications, and consider participating in local drug take-back programs.
Missing a Dose
If you miss a dose, apply a new patch as soon as possible after removing the old one. If it is close to the time for your next patch, apply the new patch and start a new schedule. Do not apply two patches at the same time or take extra doses.
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. Continue using this medication as directed by your doctor or healthcare provider, even if you feel well.
Applying the Patch
1. Remove the old patch before applying a new one.
2. Wash your hands before and after handling the patch.
3. Do not cut or divide the patches, and do not use damaged patches.
4. Apply the patch to clean, dry, healthy skin on your chest or upper arm. Rotate the site with each new patch to avoid skin irritation.
5. Choose a site without hair and avoid areas with skin folds or skin that may be rubbed by tight clothing.
6. You can bathe, shower, or swim while wearing the patch.
Securing the Patch
The patch comes with a cover to hold it in place if it comes loose. This cover does not contain any medication and should not be used alone. If the patch becomes loose, apply the cover over the patch as directed.
Skin Irritation
If the skin under the patch becomes mildly irritated, you may remove the patch and apply a new one to a different area.
Disposing of Used Patches
After removing a used patch, fold the sticky sides together and dispose of it in a secure location where children and pets cannot access it. This medication can be harmful to children if accidentally ingested or applied, so seek medical help immediately if this occurs.
Stopping the Medication
Do not stop using this medication suddenly without consulting your doctor, as this may increase the risk of side effects. If you need to stop using this medication, your doctor will instruct you on how to gradually discontinue it.
Storing and Disposing of the Medication
Store the medication at room temperature in a dry place, away from bathrooms. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications according to the instructions provided. Do not flush medications down the toilet or pour them down the drain unless instructed to do so. Check with your pharmacist for guidance on disposing of medications, and consider participating in local drug take-back programs.
Missing a Dose
If you miss a dose, apply a new patch as soon as possible after removing the old one. If it is close to the time for your next patch, apply the new patch and start a new schedule. Do not apply two patches at the same time or take extra doses.
Lifestyle & Tips
- Apply the patch to a clean, dry, hairless area of skin on the upper arm or torso. Avoid irritated or scarred skin.
- Press firmly for 10 seconds to ensure good adhesion.
- Rotate application sites weekly to prevent skin irritation.
- Do not stop using the patch suddenly, as this can cause a dangerous increase in blood pressure (rebound hypertension). Your doctor will tell you how to slowly reduce the dose if needed.
- Avoid activities requiring mental alertness, such as driving or operating machinery, until you know how the medication affects you, as it can cause drowsiness or dizziness.
- Limit alcohol consumption, as it can increase drowsiness.
- Maintain a healthy diet, regular exercise, and manage stress as part of your blood pressure control plan.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 0.1 mg/24hr patch applied once weekly. Titrate by 0.1 mg/24hr increments at 1-2 week intervals.
Dose Range:
0.1 - 0.6 mg
Condition-Specific Dosing:
hypertension:
Apply one patch (0.1 mg/24hr, 0.2 mg/24hr, or 0.3 mg/24hr) once weekly. Doses above 0.6 mg/24hr are generally not recommended.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established for hypertension; off-label use for ADHD or tic disorders may exist but requires specialized dosing.
Adolescent:
Not established for hypertension; off-label use for ADHD or tic disorders may exist but requires specialized dosing.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment, but monitor response and adverse effects.
Moderate:
Consider starting with lower doses (e.g., 0.1 mg/24hr) and titrate slowly. Monitor blood pressure and heart rate closely.
Severe:
Consider starting with lower doses (e.g., 0.1 mg/24hr) and titrate slowly. Monitor blood pressure and heart rate closely. May require less frequent patch changes.
Dialysis:
Clonidine is minimally removed by hemodialysis. Administer dose after dialysis. Monitor closely for hypotension and bradycardia.
Hepatic Impairment:
Mild:
No specific adjustment recommended.
Moderate:
No specific adjustment recommended, but use with caution and monitor for increased effects.
Severe:
No specific adjustment recommended, but use with caution and monitor for increased effects.
Pharmacology
Mechanism of Action
Clonidine is a centrally acting alpha-2 adrenergic agonist. It stimulates alpha-2 adrenergic receptors in the brainstem, which results in a reduction of sympathetic outflow from the central nervous system. This leads to a decrease in peripheral vascular resistance, renal vascular resistance, heart rate, and blood pressure.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 60-70% (oral); transdermal provides continuous, sustained absorption.
Tmax:
2-3 days (transdermal patch) to reach steady-state plasma concentrations.
FoodEffect:
Not applicable for transdermal patch.
Distribution:
Vd:
2.1 L/kg
ProteinBinding:
20-40%
CnssPenetration:
Yes
Elimination:
HalfLife:
12-24 hours (systemic, but patch provides continuous release for 7 days)
Clearance:
Not readily available for transdermal, but systemic clearance is primarily renal.
ExcretionRoute:
Renal (approximately 40-60% as unchanged drug), fecal (20%).
Unchanged:
40-60%
Pharmacodynamics
OnsetOfAction:
Within hours, but full therapeutic effect may take 2-3 days after initial patch application.
PeakEffect:
2-3 days (steady-state concentrations achieved).
DurationOfAction:
7 days (due to continuous release from the patch).
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Abnormal heartbeat (fast, slow, or irregular)
Redness
Burning sensation
Change in skin color
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for advice:
Dry mouth
Constipation
Dizziness, drowsiness, fatigue, or weakness
Headache
Upset stomach
Skin irritation
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Abnormal heartbeat (fast, slow, or irregular)
Redness
Burning sensation
Change in skin color
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for advice:
Dry mouth
Constipation
Dizziness, drowsiness, fatigue, or weakness
Headache
Upset stomach
Skin irritation
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Unusual tiredness or weakness
- Slow or irregular heartbeat
- Chest pain
- Difficulty breathing
- Severe skin rash or irritation at the patch site
- Sudden, severe headache or blurred vision (signs of rebound hypertension if stopped abruptly)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you are currently taking another medication that contains the same active ingredient as this drug.
* If you are taking any of the following medications: digoxin, diltiazem, verapamil, or beta blockers like metoprolol or propranolol.
Please note that this is not an exhaustive list of all potential interactions. To ensure your safety, it is crucial to disclose all of your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to determine whether it is safe for you to take this medication with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you are currently taking another medication that contains the same active ingredient as this drug.
* If you are taking any of the following medications: digoxin, diltiazem, verapamil, or beta blockers like metoprolol or propranolol.
Please note that this is not an exhaustive list of all potential interactions. To ensure your safety, it is crucial to disclose all of your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to determine whether it is safe for you to take this medication with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
Important Warnings and Precautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require you to be alert. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position. Be cautious when climbing stairs.
Monitoring and Interactions
Regularly check your blood pressure and heart rate as instructed by your doctor. If you have high blood pressure, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Precautions in Hot Weather and with Physical Activity
Be careful in hot weather or when engaging in physical activity. Drink plenty of fluids to prevent dehydration.
Eye Care
Dry eyes may occur with this medication. If you wear contact lenses and experience dry eyes or a change in how your lenses feel, discuss this with your doctor.
Interactions with Other Substances
Before using alcohol, marijuana or other forms of cannabis, or prescription or OTC medications that may cause drowsiness, consult your doctor.
Special Precautions
If you need to undergo an MRI, remove the patch before the procedure, as it may contain metal. Inform your doctor if you will be having procedures to regulate your heart rhythm (defibrillation, cardioversion), as they should be aware that you are taking this medication.
Skin Irritation and Allergic Reactions
If you have used a patch form of this medication and experienced skin irritation, inform your doctor. You may be more likely to develop a rash on other parts of your body with any form of this medication.
Age-Related Precautions
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You and your doctor will need to discuss the benefits and risks of this medication to you and your baby.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require you to be alert. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position. Be cautious when climbing stairs.
Monitoring and Interactions
Regularly check your blood pressure and heart rate as instructed by your doctor. If you have high blood pressure, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Precautions in Hot Weather and with Physical Activity
Be careful in hot weather or when engaging in physical activity. Drink plenty of fluids to prevent dehydration.
Eye Care
Dry eyes may occur with this medication. If you wear contact lenses and experience dry eyes or a change in how your lenses feel, discuss this with your doctor.
Interactions with Other Substances
Before using alcohol, marijuana or other forms of cannabis, or prescription or OTC medications that may cause drowsiness, consult your doctor.
Special Precautions
If you need to undergo an MRI, remove the patch before the procedure, as it may contain metal. Inform your doctor if you will be having procedures to regulate your heart rhythm (defibrillation, cardioversion), as they should be aware that you are taking this medication.
Skin Irritation and Allergic Reactions
If you have used a patch form of this medication and experienced skin irritation, inform your doctor. You may be more likely to develop a rash on other parts of your body with any form of this medication.
Age-Related Precautions
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You and your doctor will need to discuss the benefits and risks of this medication to you and your baby.
Overdose Information
Overdose Symptoms:
- Profound hypotension (very low blood pressure)
- Bradycardia (slow heart rate)
- Respiratory depression (slow, shallow breathing)
- Sedation or coma
- Miosis (pinpoint pupils)
- Hypothermia (low body temperature)
- Arrhythmias
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment is supportive, focusing on maintaining vital signs.
Drug Interactions
Major Interactions
- Beta-blockers (increased risk of bradycardia, AV block, and rebound hypertension upon withdrawal of either drug)
- Tricyclic antidepressants (TCAs) (may antagonize the hypotensive effect of clonidine)
- Other CNS depressants (e.g., alcohol, barbiturates, sedatives, hypnotics, opioids) (additive sedative effects)
Moderate Interactions
- Calcium channel blockers (additive hypotensive and bradycardic effects)
- Diuretics (additive hypotensive effects)
- Alpha-1 blockers (additive hypotensive effects)
- Digoxin (increased risk of bradycardia)
- Neuroleptics (e.g., haloperidol) (may increase risk of orthostatic hypotension)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation of therapy.
Heart Rate (HR)
Rationale: To establish baseline and monitor for bradycardia.
Timing: Prior to initiation of therapy.
Renal Function (e.g., SCr, eGFR)
Rationale: Clonidine is primarily renally excreted; impairment may necessitate dose adjustment.
Timing: Prior to initiation, especially in elderly or those with suspected renal issues.
Routine Monitoring
Blood Pressure (BP)
Frequency: Weekly during titration, then periodically (e.g., monthly or as clinically indicated) once stable.
Target: <130/80 mmHg (or individualized target)
Action Threshold: Persistent BP above target or symptomatic hypotension.
Heart Rate (HR)
Frequency: Weekly during titration, then periodically (e.g., monthly or as clinically indicated) once stable.
Target: 60-100 bpm (or individualized target)
Action Threshold: Persistent bradycardia (<50 bpm) or symptomatic bradycardia.
Adverse Effects (e.g., dry mouth, drowsiness, dizziness)
Frequency: At each visit, especially during titration.
Target: N/A
Action Threshold: Intolerable or severe adverse effects.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Drowsiness
- Dry mouth
- Constipation
- Fatigue
- Nausea
- Headache
- Skin irritation at patch site
- Symptoms of rebound hypertension (e.g., nervousness, agitation, headache, tremor, rapid rise in BP) if discontinued abruptly.
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Clonidine crosses the placenta.
Trimester-Specific Risks:
First Trimester:
Limited human data, but animal studies show adverse effects at high doses. Risk of fetal harm cannot be ruled out.
Second Trimester:
Potential for fetal bradycardia and growth restriction has been reported in some cases.
Third Trimester:
Risk of neonatal withdrawal symptoms (e.g., irritability, tremor, hypertension) if maternal clonidine is continued until delivery.
Lactation
Clonidine is excreted into breast milk. Monitor breastfed infants for sedation, bradycardia, and hypotension. Use with caution.
Infant Risk:
L3 (Moderately safe; monitor infant for adverse effects).
Pediatric Use
Safety and efficacy for hypertension in pediatric patients have not been established. Off-label use for ADHD or tic disorders is common but requires careful monitoring and specialized dosing.
Geriatric Use
Elderly patients may be more sensitive to the hypotensive and sedative effects of clonidine. Start with lower doses and titrate slowly. Monitor closely for orthostatic hypotension and bradycardia.
Clinical Information
Clinical Pearls
- The transdermal patch offers the advantage of once-weekly dosing and sustained drug release, which can improve adherence and reduce peak-trough fluctuations compared to oral formulations.
- Crucially, emphasize to patients the importance of not abruptly discontinuing clonidine due to the high risk of severe rebound hypertension, which can be life-threatening.
- Patients should be instructed on proper patch application and rotation to minimize skin irritation.
- Sedation and dry mouth are common side effects, especially at the beginning of therapy or with dose increases. These often diminish over time.
- Clonidine can be useful in patients with resistant hypertension or those who experience significant side effects from other antihypertensives, but its use is often limited by its CNS side effects.
Alternative Therapies
- Other classes of antihypertensives (e.g., ACE inhibitors, ARBs, calcium channel blockers, diuretics, beta-blockers)
- Other centrally acting alpha-2 agonists (e.g., methyldopa - less common for hypertension now)
- For ADHD/tic disorders (if used off-label): guanfacine, atomoxetine, stimulants.
Cost & Coverage
Average Cost:
$50 - $200 per 4 patches (1 month supply)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide detailed information, including the name of the medication taken, the amount, and the time it occurred.