Disclaimer: This is for informational purposes only. This does not replace the instructions you received from Dr. Anderson or any other practitioner,
constitute medical treatment, establishment of a patient-physician relationship, constitute any form of recommendation, prescription or medical
advice, or imply that the medication is appropriate or FDA approved for any condition. This information may be outdated and is not a complete
listing of instructions, doses, uses, or side effects. If this was prescribed to you, you must review this information with your pharmacist and
prescriber before starting the medication. Any medication may interfere with the ability to drive, concentrate, or operate machinery; patients must
be responsible for their own behavior and should not engage in any dangerous activity if there is any question of impairment. All medications have
side effects and drug interactions, some serious, some fatal. Let all of your practitioners and pharmacist know about every substance used. Alcohol,
herbals, or illegal drugs are not considered safe with these medications. Assume no medication is safe during pregnancy or while breast feeding. The
medication may interfere with birth control. Almost any medication can cause sleepiness, insomnia, dizziness, confusion, hallucinations, anxiety,
panic, constipation or diarrhea, headache, chest pain and nausea or vomiting, among others. These could cause physical injury, such as dizziness
causing one to fall down stairs. Many reduce blood pressure, which could cause fainting, dizziness, stroke, or other problems. Most medications
should NOT be stopped suddenly because of the risk of withdrawal. This is a supplement to the standardized drug information sheets.
Drug: CLONIDINE
Wayne E. Anderson, D.O.
A Medical Corporation
FDA-approved uses: High blood pressure.
Common off-label uses: To block pain at the peripheral nerves and
at the spinal cord. To help relieve/prevent withdrawal symptoms
from opioid/narcotic pain medications. To reduce tremor and
attention-deficit disorder, among other disorders.
Chronic Intractable Pain Disorders
Headache & Facial Pain Disorders
Neurotoxin Therapy
Alternatives: Non-medication modalities, pain interventions and
other medications that may work in a similar manner.
How it works: The mechanism of action involves alpha 2
adrenoceptors which play a moderating role in neuropathic pain.
Board Certified Neurology
American Board of Psychiatry & Neurology
Board Certified Pain Medicine
American Board of Psychiatry & Neurology
in association with the
American Board of Anesthesiology
Subspecialty Certified Headache Medicine
United Council for Neurological
Subspecialties
Qualified Medical Evaluator
Member of the
California Pacific Neuroscience Institute
Side effects: Please see the standardized drug information sheet for
detailed information about risks, side effects, interactions, and other
important information. Because clonidine lowers blood pressure, it
should be used with caution in those with low blood pressure or with
heart disease. It also should be used with caution if there is liver or
kidney dysfunction. Common side effects include everything listed in
the disclaimer as well as sleepiness, especially when the medication is
first used. Other side effects include dry mouth, dry eyes, fatigue,
headache, nausea and impotence. More serious side effects include
dizziness and lightheadedness because this may mean that the blood
pressure is too low. We ask that each patient check blood pressure at
home daily while using clonidine, looking for any change in the
regular blood pressure. Clonidine should not be stopped suddenly
because of a withdrawal syndrome: the blood pressure could go up
really high and cause serious problems. This medication is NOT to be
used without the knowledge and permission of your primary care
provider, because of the effect on blood pressure.
Common doses: Here is a sample schedule of tablets that may be
appropriate for some patients; the medication also comes as a patch
but this schedule applies to tablets. Do not increase each week unless
the medication is well tolerated. Do not increase if it is already
working.
45 Castro Street Suite 225
San Francisco CA 94114
415.558.8584 tel
415.513.4521 fax
www.wayneanderson.net
Week
Morning dose
Afternoon dose
Nighttime dose
1
none
none
0.1mg
2
0.1mg
none
0.1mg
3 and on
0.1mg
0.1mg
0.1mg
Time to effect: Clonidine may require a few weeks before clear benefit is noted. Neuropathic pain
medications may require up to 8 weeks before clear improvement is noted.
Financial: Dr. Anderson has never received payment in exchange for prescribing a medication. Dr.
Anderson has no financial interaction with the companies that manufacture clonidine.
Insurance coverage: Many medications, especially in painful conditions, are off-label as discussed
above. Insurance companies do not need to cover medications used off label but typically do provide
coverage for most medications that have good scientific evidence. There is no guarantee that any
medication will be covered.
Clinical and Scientific evidence: Some scientific evidence supportive of the use of the medication is
listed in this section. Of course, scientific information changes rapidly and the information listed may
become outdated or incorrect overnight. Clonidine has literature supportive of use in neuropathic pain
conditions including some types of headaches. Clonidine has anti-allodynic properties (1,2). Clonidine
is synergistic when used with opioid therapy (2). The mechanism of action involves alpha 2
adrenoceptors which play a moderating role in neuropathic pain (3).
References:
1.
Yamama Y, Nishikawa K, Funao T, Mori T, Asada A. Intrathecal gabapentin and clonidine synergistically inhibit allodynia in spinal
nerve-ligated rats. Life Sci. 2010 Oct 23;87(17-18):565-71. Epub 2010 Sep 24.
2.
Teasell RW, Mehta S, Aubut JA, Foulon B, Wolfe DL, Hsieh JT, Townson AF, Short C. A systematic review of pharmacologic
treatments of pain after spinal cord injury. Arch Phys Med Rehabil. 2010 May;91(5):816-31.
3.
Omiya Y, Yuzurihara M, Suzuki Y, Kase Y, Kono T. Role of alpha2-adrenoceptors in enhancement of antinociceptive effect in
diabetic mice. Eur J Pharmacol. 2008 Sep 11;592(1-3):62-6.
4.
Bussone G, Rapoport A. Acute and preventive treatment of cluster headache and other trigeminal autonomic cephalgias. Handb
Clin Neurol. 2010;97:431-42.
5.
Leone M, Attanasio A, Grazzi L, Libro G, D'Amico D, Moschiano F, Bussone G. Transdermal clonidine in the prophylaxis of
episodic cluster headache: an open study. Headache. 1997 Oct;37(9):559-60.