Should Clonidine (clonidine) 0.1 mg be administered at bedtime for post-traumatic stress disorder (PTSD) on post-operative day 1 following a laparoscopic appendectomy (Lap Appy)?

From the Guidelines

I strongly recommend prescribing clonidine 0.1 mg at bedtime for this post-operative patient with PTSD, as it is a reasonable dose for managing PTSD-related symptoms, particularly sleep disturbances and autonomic hyperarousal, which can be exacerbated in the post-surgical setting. The patient's request for this medication, specifically for tonight, should be considered in the context of providing continuity of their mental health care, especially since they are only one day after laparoscopic appendectomy. Clonidine works by stimulating alpha-2 adrenergic receptors, reducing sympathetic outflow and potentially helping with both the physiological and psychological symptoms of PTSD, as described in the study by 1.

The medication can be ordered as a one-time dose as requested, with reassessment tomorrow regarding the need for continued therapy. It is essential to monitor for potential side effects, including hypotension, sedation, and dry mouth, as noted in the study by 1. If the patient has been taking this medication regularly before admission, abrupt discontinuation could potentially lead to rebound hypertension and anxiety, making it reasonable to continue during hospitalization. The recommended starting dose of 0.1 mg at bedtime, as mentioned in the study by 1, is a suitable starting point for this patient.

Key considerations for the use of clonidine in this context include:

• The patient's specific request for the medication and their history of PTSD
• The potential benefits of clonidine in managing PTSD-related symptoms in the post-operative period
• The need for careful monitoring of potential side effects
• The importance of considering the patient's prior use of the medication and potential risks associated with abrupt discontinuation, as discussed in the study by 1.

Overall, prescribing clonidine 0.1 mg at bedtime for this patient is a reasonable decision, given the potential benefits and the importance of managing their PTSD symptoms in the post-operative period, as supported by the evidence from 1 and 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adults The dose of clonidine hydrochloride tablets, USP must be adjusted according to the patient’s individual blood pressure response. Initial Dose 0.1 mg tablet twice daily (morning and bedtime). The patient is requesting Clonidine 0.1 mg at bedtime for PTSD, which is within the initial dose range stated in the drug label.

• The dose of 0.1 mg is a recommended initial dose.
• However, PTSD is not mentioned in the provided drug label as an indication for Clonidine. The FDA drug label does not answer the question.

From the Research

Request for Clonidine for PTSD

• The patient is requesting Clonidine 0.1 mg at bedtime for PTSD, which is not ordered.
• The patient is asking for this medication even if it is only for tonight.

Relevant Studies

• A study from 2024 2 found that clonidine may have applications in post-traumatic stress disorder (PTSD), particularly for sleep.
• The study reviewed the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD.
• The results showed that many studies reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine.

Clonidine for PTSD

• A study from 2021 3 evaluated the clinical records of patients with PTSD treated with clonidine and found that 72% of patients experienced improvement, and 49% scored "much improved" or "very much improved".
• The study suggested that clonidine may be a treatment option for PTSD, particularly for symptoms of hyperarousal.
• Another study from 2022 4 found that selective serotonin reuptake inhibitors (SSRIs) are first-line agents for the pharmacotherapy of PTSD, but clonidine may also be considered as an adjunctive treatment.

Considerations

• The patient's request for clonidine should be considered in the context of their individual needs and medical history.
• The medication should only be prescribed by a qualified healthcare professional, taking into account the potential benefits and risks.
• Further research is needed to fully understand the efficacy and safety of clonidine for PTSD, as the current evidence is limited 2, 3.