From the Guidelines
Abrupt withdrawal from clonidine can cause a rebound hypertensive crisis and other severe symptoms, and therefore, clonidine should always be tapered gradually under medical supervision, typically over 1-2 weeks, to avoid these dangerous effects. These symptoms typically begin 12-48 hours after stopping the medication and may include dangerous spikes in blood pressure, rapid heart rate, anxiety, agitation, tremors, headache, nausea, vomiting, sweating, flushing, and insomnia. More severe cases can involve confusion, hallucinations, and even seizures. The severity of withdrawal depends on the dose and duration of clonidine use. These symptoms occur because clonidine suppresses norepinephrine release in the brain, and sudden discontinuation leads to a surge of this neurotransmitter, causing sympathetic nervous system overactivity.
Some of the key symptoms of abrupt withdrawal from clonidine include:
- Dangerous spikes in blood pressure
- Rapid heart rate
- Anxiety
- Agitation
- Tremors
- Headache
- Nausea
- Vomiting
- Sweating
- Flushing
- Insomnia
- Confusion
- Hallucinations
- Seizures
As noted in the study by 1, rebound hypertension after abrupt clonidine discontinuation has been observed, and therefore, these medications should be tapered off rather than suddenly discontinued. The study also highlights the importance of monitoring vital signs in patients receiving clonidine treatment, especially in those with underlying cardiovascular conditions.
It is essential to seek immediate medical attention if you experience withdrawal symptoms, as treatment may require blood pressure management and restarting clonidine with a proper tapering schedule. This is especially important for patients with underlying cardiovascular conditions who face higher risks during withdrawal.
In terms of the tapering schedule, the study by 1 suggests that clonidine must be tapered to avoid rebound hypertension, and this should be done under medical supervision. The exact tapering schedule may vary depending on the individual patient and the dose and duration of clonidine use, but typically, it is recommended to taper the medication over 1-2 weeks.
Overall, the evidence suggests that abrupt withdrawal from clonidine can have severe consequences, and therefore, it is crucial to taper the medication gradually under medical supervision to avoid these effects.
From the FDA Drug Label
WARNINGS Withdrawal Patients should be instructed not to discontinue therapy without consulting their physician. Sudden cessation of clonidine treatment has, in some cases, resulted in symptoms such as nervousness, agitation, headache, and tremor accompanied or followed by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma Rare instances of hypertensive encephalopathy, cerebrovascular accidents and death have been reported after clonidine withdrawal
The symptoms of abrupt withdrawal from clonidine include:
- Nervousness
- Agitation
- Headache
- Tremor
- Rapid rise in blood pressure
- Elevated catecholamine concentrations in the plasma
- Rare instances of hypertensive encephalopathy, cerebrovascular accidents, and death 2
From the Research
Symptoms of Abrupt Withdrawal from Clonidine
- Rebound hypertension
- Tachycardia
- Symptoms of sympathetic overactivity
- Increased catecholamine excretion 3
- Impaired endothelium-dependent relaxation
- Increased GRK2 activity
- Reduced Akt/endothelial NO synthase (eNOS)/NO production in aortas 4
Prevention of Rebound Hypertension
- Gradual clonidine withdrawal has been recommended, but does not always avoid the reaction 3
- Co-treatment with clonidine and a GRK2 inhibitor prevented rebound hypertension and endothelial dysfunction after withdrawal in diabetes 4
- A regimen comprising high doses of the alpha 1-adrenoceptor antagonist, prazosin, the cardioselective beta-blocker, atenolol, and chlordiazepoxide, specifically designed to counter both central and peripheral effects of sudden withdrawal of a central alpha 2-adrenoceptor agonist, was completely successful in preventing the haemodynamic and symptomatic features of clonidine withdrawal in eight hypertensive patients 3
Related Information
- Beta blocker rebound phenomenon can have dangerous consequences, including a fourfold increased risk of events related to coronary artery disease in hypertensive patients, increased in-hospital mortality in heart failure patients, and precipitation of angina pectoris attack 5
- Beta-blockers appear to be substantially less protective against stroke and overall mortality compared with other antihypertensive agents, but exhibit a substantial risk-reducing ability for all events when prescribed to lower BP in patients with modest or more clear BP elevations 6