Catapres Tts-2 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?
Clonidine is a medication applied as a patch to your skin once a week to help lower high blood pressure. It works by relaxing blood vessels and slowing your heart rate.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Continue using the medication as directed, even if you start to feel better.
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.
5. Choose a site without hair and avoid areas with irritated or damaged skin, skin folds, or skin that may be rubbed by tight clothing.
Wearing the Patch
You can bathe, shower, or swim while wearing the patch. If the patch comes loose, use the provided patch cover to hold it in place. Note that the patch cover does not contain any medication and should not be used alone.
Skin Irritation
If the skin under the patch becomes mildly irritated, you can 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, inhaled, or applied to the skin. If this happens, seek medical help immediately.
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 the medication, your doctor will instruct you on how to gradually discontinue it.
Storage and Disposal
Store the medication at room temperature in a dry place, away from bathrooms. Keep all medications in a safe location, out of reach of children and pets. Dispose of unused or expired medications according to the instructions provided. Do not flush them down the toilet or pour them down the drain unless instructed to do so. Check with your pharmacist for guidance on proper disposal, and consider participating in local drug take-back programs.
Missed 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 correctly, follow your doctor's instructions and read all the information provided. Continue using the medication as directed, even if you start to feel better.
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.
5. Choose a site without hair and avoid areas with irritated or damaged skin, skin folds, or skin that may be rubbed by tight clothing.
Wearing the Patch
You can bathe, shower, or swim while wearing the patch. If the patch comes loose, use the provided patch cover to hold it in place. Note that the patch cover does not contain any medication and should not be used alone.
Skin Irritation
If the skin under the patch becomes mildly irritated, you can 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, inhaled, or applied to the skin. If this happens, seek medical help immediately.
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 the medication, your doctor will instruct you on how to gradually discontinue it.
Storage and Disposal
Store the medication at room temperature in a dry place, away from bathrooms. Keep all medications in a safe location, out of reach of children and pets. Dispose of unused or expired medications according to the instructions provided. Do not flush them down the toilet or pour them down the drain unless instructed to do so. Check with your pharmacist for guidance on proper disposal, and consider participating in local drug take-back programs.
Missed 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 your upper arm or torso. Avoid irritated or broken skin.
- Rotate the application site each week to prevent skin irritation.
- Do not cut the patch.
- Do not stop using this medication suddenly, as it can cause a dangerous increase in blood pressure (rebound hypertension). If you need to stop, your doctor will gradually reduce your dose.
- Avoid activities requiring mental alertness, such as driving or operating machinery, until you know how this medication affects you, as it can cause dizziness or drowsiness.
- Avoid alcohol and other sedating medications, as they can increase drowsiness.
- Report any severe skin reactions at the patch site to your doctor.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 0.1 mg/24hr patch applied once weekly. Titrate weekly by 0.1 mg/24hr increments. Maintenance: 0.1 to 0.3 mg/24hr weekly.
Dose Range:
0.1 - 0.3 mg
Condition-Specific Dosing:
Hypertension:
Apply one patch weekly to a hairless area of intact skin on the upper arm or torso. Rotate application sites.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established for hypertension (oral form sometimes used off-label for ADHD/tics)
Adolescent:
Not established for hypertension (oral form sometimes used off-label for ADHD/tics)
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment, but monitor closely.
Moderate:
Consider starting with lower doses (e.g., 0.1 mg/24hr) and titrating slowly based on response and tolerability.
Severe:
Consider starting with lower doses (e.g., 0.1 mg/24hr) and titrating slowly; longer dosing intervals may be necessary.
Dialysis:
Clonidine is minimally removed by hemodialysis. Supplementation after dialysis is generally not required, but monitor blood pressure closely.
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 presynaptic alpha-2 adrenergic receptors in the brainstem, which results in a reduction of sympathetic outflow from the central nervous system. This leads to decreased peripheral vascular resistance, heart rate, and blood pressure.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 90% (oral); transdermal system provides continuous delivery.
Tmax:
Achieves steady-state plasma concentrations within 2-3 days after transdermal application.
FoodEffect:
Not applicable for transdermal patch.
Distribution:
Vd:
Approximately 2.1 L/kg
ProteinBinding:
20-40%
CnssPenetration:
Yes
Elimination:
HalfLife:
12-24 hours (can be prolonged in renal impairment)
Clearance:
Approximately 200 mL/min
ExcretionRoute:
Renal (primarily), also fecal
Unchanged:
40-60% (renal)
Pharmacodynamics
OnsetOfAction:
2-3 days (for steady-state with transdermal patch)
PeakEffect:
Achieved at steady-state plasma concentrations (2-3 days)
DurationOfAction:
7 days (with weekly patch application)
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:
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 not mentioned here. 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:
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 not mentioned here. 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 (signs of low blood pressure)
- Slow heart rate (bradycardia)
- Sudden, severe headache, blurred vision, or chest pain (signs of rebound hypertension if stopped abruptly)
- Severe skin rash, itching, or swelling at the patch site
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 allergic reaction you experienced, including any symptoms that occurred.
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 with this medication. To ensure your safety, it is crucial to disclose all of your medications, including:
Prescription and over-the-counter (OTC) drugs
Natural products
Vitamins
Additionally, inform your doctor about any existing health problems. It is vital to verify that it is safe to take this medication with all of your current medications and health conditions. Never start, stop, or change the dosage 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 allergic reaction you experienced, including any symptoms that occurred.
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 with this medication. To ensure your safety, it is crucial to disclose all of your medications, including:
Prescription and over-the-counter (OTC) drugs
Natural products
Vitamins
Additionally, inform your doctor about any existing health problems. It is vital to verify that it is safe to take this medication with all of your current medications and health conditions. Never start, stop, or change the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and be cautious when climbing stairs.
As directed by your doctor, regularly monitor your blood pressure and heart rate. If you have high blood pressure and are taking this medication, 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.
Be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent dehydration.
This medication may cause dry eyes. If you wear contact lenses and experience dry eyes or a change in how your lenses feel, discuss this with your doctor.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or OTC medications that may slow your reactions, consult your doctor.
The patch form of this medication may contain metal, so remove it before undergoing a magnetic resonance imaging (MRI) scan. If you are scheduled to undergo procedures to regulate your heart rhythm, such as defibrillation or cardioversion, inform your doctor that you are taking this medication.
If you have previously experienced skin irritation from a patch form of this medication, talk to your doctor, as you may be more likely to develop a rash on other parts of your body with any form of this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and be cautious when climbing stairs.
As directed by your doctor, regularly monitor your blood pressure and heart rate. If you have high blood pressure and are taking this medication, 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.
Be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent dehydration.
This medication may cause dry eyes. If you wear contact lenses and experience dry eyes or a change in how your lenses feel, discuss this with your doctor.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or OTC medications that may slow your reactions, consult your doctor.
The patch form of this medication may contain metal, so remove it before undergoing a magnetic resonance imaging (MRI) scan. If you are scheduled to undergo procedures to regulate your heart rhythm, such as defibrillation or cardioversion, inform your doctor that you are taking this medication.
If you have previously experienced skin irritation from a patch form of this medication, talk to your doctor, as you may be more likely to develop a rash on other parts of your body with any form of this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks 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, somnolence, coma
- Miosis (pinpoint pupils)
- Hypothermia
What to Do:
Seek immediate medical attention or call 911. For poison control, call 1-800-222-1222. Management is supportive, focusing on maintaining blood pressure and respiration. Naloxone may be considered in severe cases of respiratory depression, though its efficacy is variable.
Drug Interactions
Major Interactions
- Beta-blockers (increased risk of bradycardia, AV block; potential for exaggerated rebound hypertension upon withdrawal of either drug)
- Tricyclic antidepressants (TCAs) (may antagonize the antihypertensive effect of clonidine)
- Other CNS depressants (e.g., alcohol, barbiturates, benzodiazepines, opioids, sedatives, hypnotics) (additive sedative effects)
Moderate Interactions
- Diuretics (additive hypotensive effects)
- Other antihypertensives (additive hypotensive effects)
- Alpha-blockers (may enhance hypotensive effects)
- Digitalis glycosides (increased risk of bradycardia)
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 eliminated; 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: Individualized, typically <130/80 mmHg for most adults.
Action Threshold: Persistent hypotension (e.g., systolic <90 mmHg or symptomatic) or uncontrolled hypertension.
Heart Rate (HR)
Frequency: Weekly during titration, then periodically (e.g., monthly or as clinically indicated) once stable.
Target: Individualized, typically 60-100 bpm.
Action Threshold: Persistent bradycardia (e.g., <50 bpm or symptomatic).
Patch Adhesion/Skin Reaction
Frequency: With each patch change.
Target: Not applicable
Action Threshold: Significant erythema, rash, or irritation at application site.
Symptom Monitoring
- Dizziness
- Sedation/Drowsiness
- Dry mouth
- Constipation
- Fatigue
- Nausea
- Headache
- Rebound hypertension (if patch is abruptly discontinued)
Special Patient Groups
Pregnancy
Use in pregnancy should only occur if the potential benefit justifies the potential risk to the fetus. Clonidine crosses the placenta. Neonatal withdrawal symptoms (e.g., jitteriness, irritability, poor feeding) have been reported following maternal use of clonidine during pregnancy, particularly with chronic use.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless clearly needed.
Second Trimester:
Potential for fetal exposure and effects.
Third Trimester:
Increased risk of neonatal withdrawal symptoms if used chronically until delivery.
Lactation
Clonidine is excreted into breast milk. The American Academy of Pediatrics considers clonidine to be compatible with breastfeeding, but caution is advised. Monitor the infant for signs of sedation, bradycardia, or other adverse effects.
Infant Risk:
Low to moderate; monitor for sedation, bradycardia, and poor feeding.
Pediatric Use
Safety and efficacy of clonidine transdermal patches for hypertension in pediatric patients have not been established. Oral clonidine is sometimes used off-label for conditions like ADHD or tic disorders in children.
Geriatric Use
Elderly patients may be more sensitive to the hypotensive and sedative effects of clonidine. Initiate therapy with lower doses and titrate slowly, monitoring closely for adverse effects.
Clinical Information
Clinical Pearls
- Rebound hypertension is a significant risk if clonidine is discontinued abruptly, especially with higher doses or concomitant beta-blocker use. Taper dose gradually over 2-4 days.
- Transdermal patches offer convenience and improved compliance due to once-weekly application, but onset of action is slower than oral forms.
- Common side effects include dry mouth, drowsiness, and dizziness, which often diminish with continued therapy.
- Skin reactions at the application site (erythema, pruritus, rash) are common and may necessitate discontinuation in some patients. Rotate application sites.
- Clonidine can be useful in patients with resistant hypertension or those who experience significant side effects from other antihypertensives.
- Patients should be advised not to cut or alter the patch in any way.
Alternative Therapies
- Other centrally acting alpha-2 adrenergic agonists (e.g., guanfacine)
- Thiazide diuretics
- ACE inhibitors (ACEIs)
- Angiotensin receptor blockers (ARBs)
- Calcium channel blockers (CCBs)
- Beta-blockers
- Other classes of antihypertensives depending on patient comorbidities and specific indications.
Cost & Coverage
Average Cost:
Varies widely by strength and pharmacy; typically $50-$200+ per 4 patches (1 month supply)
Generic Available:
Yes
Insurance Coverage:
Often Tier 1 or 2 for generic, Tier 3 or higher for brand.
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to 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 seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.