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 common symptoms of Clonidine withdrawal are:
- Nervousness
- Agitation
- Headache
- Tremor These symptoms can be accompanied by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma. In rare cases, Clonidine withdrawal can lead to hypertensive encephalopathy, cerebrovascular accidents, and death 1.
From the Research
Clonidine withdrawal can cause potentially life-threatening symptoms, including rebound hypertension, and should be tapered gradually under medical supervision to avoid these complications. The symptoms of clonidine withdrawal typically begin 12-48 hours after stopping the medication and may last for 1-2 weeks, including agitation, anxiety, headache, tremors, nausea, vomiting, sweating, rapid heart rate, and insomnia 2. The severity of these symptoms depends on the dose and duration of treatment, with higher doses and longer treatment durations associated with more severe withdrawal symptoms. Clonidine suppresses norepinephrine release in the brain, and when stopped abruptly, there's a surge of this neurotransmitter causing sympathetic nervous system overactivity, leading to the withdrawal symptoms.
Some key points to consider when managing clonidine withdrawal include:
- The importance of gradual tapering of the medication under medical supervision to minimize the risk of rebound hypertension and other withdrawal symptoms 2
- The need for close monitoring of blood pressure during the tapering process to promptly identify and manage any potential complications
- The potential for clonidine withdrawal to occur even with gradual tapering, highlighting the importance of careful planning and monitoring during the withdrawal process 3
- The risk of clonidine withdrawal in pediatric patients, who may be more susceptible to the effects of the medication and require closer monitoring during the withdrawal process 2
To manage clonidine withdrawal safely and effectively, it is essential to:
- Taper the medication gradually over 1-2 weeks under medical supervision
- Monitor blood pressure closely during the tapering process
- Be aware of the potential for rebound hypertension and other withdrawal symptoms, and have a plan in place to manage these complications if they occur
- Ensure that patients taking clonidine do not run out of medication and can contact their healthcare provider immediately if they experience any withdrawal symptoms 4, 5