From the Guidelines
Clonidine is used to relieve symptoms of nausea, vomiting, and diarrhea in patients withdrawing from opioids. This medication works by acting on alpha-2 adrenergic receptors in the central nervous system, which helps reduce the hyperactivity of the sympathetic nervous system that occurs during opioid withdrawal 1. When a person stops using opioids, their body experiences a rebound in autonomic activity, leading to these uncomfortable gastrointestinal symptoms along with other withdrawal effects like anxiety, sweating, and elevated blood pressure. Clonidine effectively manages these physical withdrawal symptoms by decreasing norepinephrine release, though it does not directly prevent opioid cravings or address the psychological aspects of addiction.
Some key points to consider when using clonidine for opioid withdrawal include:
- Clonidine suppresses withdrawal symptoms but may cause orthostasis or hypotension in some patients, necessitating small initial doses and careful titration 1
- The medication is typically prescribed at low doses initially and may be adjusted based on symptom control
- Patients should be monitored for potential side effects such as hypotension, dizziness, and sedation while taking clonidine during the withdrawal process
- Other medications, such as buprenorphine, may be more effective in managing opioid withdrawal symptoms, but clonidine can be a useful adjunctive therapy 1
It's worth noting that clonidine does not stimulate autonomic activity, but rather helps to reduce the hyperactivity of the sympathetic nervous system that occurs during opioid withdrawal. Additionally, while clonidine may help alleviate some symptoms of opioid withdrawal, it is not intended to prevent opioid craving or reduce somnolence and drowsiness.
From the FDA Drug Label
WARNINGS Withdrawal Patients should be instructed not to discontinue therapy without consulting their physician. The FDA drug label does not answer the question.
From the Research
Rationale for Clonidine Use
The nurse practitioner will tell the patient that clonidine is used to:
- Relieve symptoms of nausea, vomiting, and diarrhea, as well as other symptoms associated with opioid withdrawal 2, 3, 4
- Clonidine is a central alpha adrenergic agonist that can be used to treat the opiate withdrawal syndrome, producing marked reduction of withdrawal symptoms 2
- Prevent opioid craving, as clonidine maintenance prolongs opioid abstinence and decouples stress from craving in daily life 5
Mechanism of Action
Clonidine seems best suited for use as a transitional treatment between opiate dependence and induction onto the opiate antagonist naltrexone 4
- Clonidine is an important new treatment option for selected opiate addicts and may be the treatment of choice when detoxification using methadone is inappropriate, unsuccessful, or unavailable 4
Side Effects and Considerations
Dosage regimens of clonidine must be individualized according to symptoms and side effects and closely supervised because of varying sensitivity to clonidine's sedative, hypotensive, and withdrawal-suppressing effects 4