Clonidine 0.2mg/24h Weekly Patches

Clonidine is a centrally acting alpha-2 adrenergic agonist. It stimulates alpha-2 adrenergic receptors in the brainstem, primarily in the vasomotor center. This stimulation leads to a reduction in sympathetic outflow from the central nervous system, resulting in decreased peripheral vascular resistance, heart rate, and blood pressure. It also reduces plasma renin activity and circulating catecholamine levels.

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, including fast, slow, or irregular rhythms
Redness
Burning sensation
Changes 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 have mild 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. 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.

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 drug interactions or health problems that may affect your use of this medication.

To ensure your safety, it is crucial to inform your doctor and pharmacist about all the medications you are taking, including:

Prescription and over-the-counter (OTC) medications
Natural products
Vitamins

Additionally, share any health problems you have with your doctor. This information will help your doctor determine whether it is safe for you to take this medication with your other medications and health conditions.

Do not start, stop, or change the dose of any medication without first consulting your doctor.

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 exercise caution when climbing stairs.

As directed by your doctor, regularly monitor your blood pressure and heart rate. 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.

In hot weather or during physical activity, be cautious 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 impair 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 the 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, planning to become pregnant, or breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.

• Beta-blockers (increased risk of bradycardia, AV block, and rebound hypertension upon clonidine withdrawal)
• Tricyclic antidepressants (TCAs) (may antagonize the hypotensive effect of clonidine)
• CNS depressants (e.g., alcohol, barbiturates, benzodiazepines, opioids) (additive sedative effects)
• Other antihypertensives (additive hypotensive effects)

• Calcium channel blockers (additive bradycardia/hypotension)
• Digoxin (additive bradycardia)
• Diuretics (additive hypotensive effects)
• Alpha-1 blockers (additive hypotensive effects)
• Neuroleptics (e.g., haloperidol) (may increase risk of orthostatic hypotension)
• MAO inhibitors (theoretical risk of hypertensive crisis, though less common with clonidine than other sympathomimetics)

• NSAIDs (may reduce hypotensive effect of clonidine)

• Dizziness
• Lightheadedness
• Fainting (syncope)
• Dry mouth
• Drowsiness
• Sedation
• Fatigue
• Constipation
• Nausea
• Headache
• Application site reactions (redness, itching, rash)
• Symptoms of rebound hypertension upon withdrawal (nervousness, agitation, headache, tremor, rapid rise in BP)

Clonidine is classified as Pregnancy Category C. Animal studies have shown adverse effects on the fetus, but there are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus. Abrupt discontinuation during pregnancy can be dangerous.

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 sedation, bradycardia, or other adverse effects.

Safety and efficacy of clonidine patches for hypertension in pediatric patients have not been established. Oral clonidine is used off-label for ADHD and tic disorders in children, but transdermal formulation is less common for these indications in this population.

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, bradycardia, and CNS depression. Renal function should be assessed, as age-related decline in renal function may necessitate dose adjustment.

• Transdermal clonidine offers once-weekly dosing, which can improve adherence compared to oral formulations.
• It has a slower onset and offset of action compared to oral clonidine, which may reduce the severity of rebound hypertension if a dose is missed, but abrupt discontinuation should still be avoided.
• Patients should be educated on proper patch application and rotation to minimize skin irritation.
• The patch should be removed before MRI procedures due to the aluminum backing, which can cause skin burns.
• Clonidine can cause significant dry mouth and drowsiness, especially at the beginning of therapy or with dose increases.
• Always taper clonidine slowly over 2-4 days (or longer) when discontinuing to prevent rebound hypertension, even with the patch formulation.
• Consider the transdermal patch for patients who have difficulty swallowing pills or prefer a less frequent dosing schedule.

• Other centrally acting alpha-2 agonists (e.g., guanfacine - oral)
• Thiazide diuretics (e.g., hydrochlorothiazide)
• ACE inhibitors (e.g., lisinopril)
• Angiotensin Receptor Blockers (ARBs) (e.g., losartan)
• Beta-blockers (e.g., metoprolol)
• Calcium channel blockers (e.g., amlodipine)
• Other classes of antihypertensives depending on patient comorbidities and specific indications.

If your symptoms or health issues persist or worsen, it is 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 it's a good idea to check with your pharmacist. 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 detailed information about the overdose, including the medication taken, the amount, and the time it occurred.