Q. I took clonidine for several years to help with both blood pressure and hot flashes. I took the pill only at night. The nightmares didn’t start right away, but after they did, they became progressively more frequent until they were occurring about once every week or so. I became afraid to go to bed anymore, not knowing if I’d wake up in a panic from another nightmare. I also suffered sleep paralysis, which is very scary.
A. Clonidine (Catapres) is a unique blood pressure drug that was first approved by the FDA in 1974. It was first available as a tablet and then later also as a transdermal skin patch (Catapres-TTS).
Although the FDA has approved clonidine only for treating hypertension, physicians prescribe it for a number of “off-label” uses to:

  • Ease symptoms of withdrawal from narcotic pain relievers
  • Ease symptoms of withdrawal from nicotine
  • Relieve hot flashes of menopause
  • Alleviate nerve pain associated with diabetes (diabetic neuropathy)
  • Help control pain caused by cancer
  • Help control symptoms of ADHD

How well clonidine works for these off-label uses remains controversial. Without large-scale, long-term, well-controlled scientific trials it is hard to really know.

Clonidine & Nightmares:

If you check most monographs or standard references for clonidine you will not discover nightmares or sleep paralysis as a side effect. But if you dig a bit deeper into the official prescribing information you will discover that “sleep disorder, and vivid dreams or nightmares” are listed. How common these symptoms are is anyone’s guess. In one informal, web-based study, we found that this side effect may take several months to show up. As a result, it would never have been reported in clinical trials and consequently it isn’t in the standard list of side effects.
Sleep paralysis is another side effect that could easily be missed in clinical trials. That’s because investigators rarely question subjects about this sort of adverse reaction. It can indeed be a terrifying experience. Sleep paralysis sometimes happens upon awakening, when the person just begins to regain consciousness but has no muscle control and feels paralyzed. To get a sense of what this scary situation is like, you may wish to read this account from one of our visitors.

Other Side Effects of Clonidine (Catapres)

  • Dry mouth (40% of patients may experience); dry nose
  • Drowsiness, sedation, fatigue (one third of patients may experience)
  • Dizziness (16% of patients may experience)
  • Constipation (10% of patients may experience); stomach pain, loss of appetite
  • Low blood pressure, especially upon standing (dizziness)
  • Blurred vision, dry eyes
  • Headache
  • Anxiety, nervousness, agitation, restlessness
  • Delirium, delusions, hallucinations, depression
  • Hair loss, rash, hives, itching
  • Fever
  • Sexual problems, loss of libido, erectile dysfunction, urinary difficulties
  • Slow pulse, arrhythmias, irregular heart rate
  • Blood disorders
  • Muscle cramps, leg cramps, joint pain

Does Clonidine Have Anticholinergic Activity?

One of the more disconcerting complications of clonidine is its anticholinergic-like activity. Many health professionals are not aware that this blood pressure drug might alter the way the body reacts to the neurochemical acetylcholine (hence its possible anticholinergic action). But when you see symptoms such as dry mouth, dry eyes, constipation, drowsiness, blurred vision, difficult urination and confusion, they are red flags that the drug could have substantial anticholinergic activity. That means that older people (over the age of 65) could be extremely vulnerable to brain fog, delirium or hallucinations. And such complications could lead to a false diagnosis of Alzheimer’s disease or dementia. To learn more about this under-recognized problem we suggest either our Guide to Drugs and Older People or the chapter on senior citizens in our book Top Screwups Doctors Make and How to Avoid Them. There is not yet adequate research to prove clonidine has strong anticholinergic action, but the common symptoms of this drug are so suggestive that we think researchers should examine this possibility seriously.

Clonidine Withdrawal: A Potentially Deadly Reaction

NEVER stop taking clonidine suddenly! Missing a dose of clonidine can cause a serious or even potentially life-threatening withdrawal reaction. Symptoms can include anxiety, agitation, headache, tremor and worst of all, a sudden spike in blood pressure. The blood pressure elevation can be so great as to trigger a stroke. Although the FDA advises a gradual withdrawal if clonidine must be discontinued, the agency doesn’t provide much detail. Here are the FDA’s recommendations:
“When discontinuing therapy with CATAPRES [clonidine] tablets, the physician should reduce the dose gradually over 2 to 4 days to avoid withdrawal symptomatology.”
The FDA also warns that if a person is taking clonidine and has to undergo surgery:
“Administration of Catapres® (clonidine hydrochloride, USP) tablets should be continued to within 4 hours of surgery and resumed as soon as possible thereafter. Blood pressure should be carefully monitored during surgery and additional measures to control blood pressure should be available if required.”

BOTTOM LINE:

Clonidine comes with a lot of unpleasant baggage. Although it may be a good choice for some patients, we think it should rarely, if ever, be prescribed to older patients. It is on the “Beers List” of drugs older people should generally avoid. (Other medications on the Beers List can be found in both our Guide to Drugs and Older People and our book Top Screwups Doctors Make and How to Avoid Them.
Have you ever taken clonidine? How well did it work to control your blood pressure? Did your doctor prescribe it for one of the off-label uses listed above? If so, did it work? Did you experience side effects? We would like to learn more about your experience, so please use the space below to enter your comment. Thanks for sharing your story.

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  1. jennifer
    United States
    Reply

    My doctor prescribed me CLONIDINE HCL 0.1 MG TABLET back in August 2015, after I told him I discontinued taking TERAZOSIN 2 MG CAPSULE. Every night since I’ve taken the Clonidine, I wake up severe headaches, and I wake up constantly throughout the night. I’ve experienced terrifying nightmares.
    When I tell my doctor these things, he brushes it off and makes jokes about the fact I’m allergic too so many medications.
    When I don’t take it at night, I don’t experience the headaches.

  2. Brad
    Florida
    Reply

    I have been on this medication for 7 years. Turns out back surgery that was successful eliminated my pain. My BP prior to surgery was 210/110 on good day. This was with taking chlonodine and 320 diovan. After surgery and pain was 90% gone, my BP shot to normal, then very low. Where I became dizzy, confused and exhausted. Called Cardioligist office with BP and told to go er. They didn’t even listen to me about chlonodine. Never went er and cut pills in half. Was obvious was meds.

  3. Mike
    Florida
    Reply

    I was involved in 2 near fatal car accidents over the past 6 years; both times I was hit by a drunk driver. I was in Pain Management for the entire time taking Dilaudid or Morphine or Opana or OxyContin for the entire 6 years. Although these drugs did control my pain, they also controlled my life. The side effects were awful. I asked my physician to taper me off and he did although he wasn’t confident I could function without pain medication. He suggested Clonidine .1mg BID to start. I tried it for a month. It did help my migraines I started having after the first accident, but no notable pain relief. At my last appointment, he prescribed .2mg TID. Within 2 days, I noticed a significant (not all, but noticeable) reduction in pain and I was having no opiate withdrawal. He was concerned about my B/P bottoming out, so he asked that I make a journal wherein I recorded my B/P 2X a day for a month. In 3 months, if things remain stable with my B/P, we are going to go to .3mg TID. For me the minor side effects of dry mouth, partial insomnia and occasional dizziness are well worth it to remain off opiate based medications. I should add that I do have hypertension so it helps that condition as well. Clonidine has worked miracles for me.

  4. Jerry
    NV
    Reply

    Dry mouth is much worse at night especially when getting up in the AM. Dreams, although not hallucinations, are like watching a bright movie and creating a script at the same time. Furthermore they are in color. I have been waking up with Heavy Legs and it takes a bit of walking to rid the feeling. I started taking a Magnesium supplement and it seem to help a bit. I am 75 and the tablet seems to be making me feel washed out.

    I tire easily and cannot even do half my walking routine on a treadmill that I could do before taking this med. For me this was the med of last resort as I am allergic to all the others. I was on Amlodipine for two years and developed a severe case of Bradycardia with irregular heartbeat. It is non recoverable so now I have a pace maker.

  5. Jerry
    NV
    Reply

    Dry mouth is much worse at night especially when getting up in the AM. Dreams, although not hallucinations, are like watching a bright movie and creating a script at the same time. Furthermore they are in color. I have been waking up with Heavy Legs and it takes a bit of walking to rid the feeling. I started taking a Magnesium supplement and it seem to help a bit. I am 75 and the tabled seems to be making me feel washed out. I tire easily and cannot even do half my walking routine on a treadmill that I could do before taking this med. For me this was the med of last resort as I am allergic to all the others. I was on Amlodipine for two years and developed a severe case of Bradycardia with irregular heartbeat. It is non recoverable so now I have a pace maker.

  6. Julie
    Chicago
    Reply

    This drug definitely causes weird sleep issues for me. I often wake up suddenly and see things that aren’t there. A few times it’s been spider hanging down over my bed, and last night I woke up suddenly and thought there was a purse on the end of my bed that wasn’t there. It usually takes me about 5 seconds to realize the these things aren’t there and I can’t touch them. This only happens on nights I take it, I’ve never had any sleep issues before. I tried stopping the pill for a few weeks just to make sure and last night I had the weird purse dream after taking it. So weird!

  7. Jennifer
    Reno, Nevada
    Reply

    My 6 year old was prescribed Clonidine for ADHD about 3 weeks ago. My main concern prior to medication was his inability to control his behavior (impulse control) and he was like a ping pong ball (but GREAT in school and EXTREMELY INTELLIGENT!) It has been 3 weeks since he started and I don’t know who my son is – it’s like he is possessed. Has anyone else experienced this? He now argues over everything, is constantly angry and has begun to physically fight me and his Dad.

    His personality that used to light up a room has disappeared and I am devastated and scared and worried! This isn’t my child!!!

    He also has nightmares every single night and is up constantly and before he never had any issues with sleep.

    Can anyone help with any advice? He started out on 1/2 of a 0.1 tablet and after 4 days we moved up to 1 full 0.1 tablet every night. Last night and tonight I have decreased it down to 1/2 of a 0.1 tablet again in hopes to get him off of Clonidine – My amazing son has disappeared and it is absolutely frightening.

  8. Doris
    nz
    Reply

    These comments have been so helpful as I have been prescribed clonidine twice daily for migraines when I have eventually come off Topamax which is attacking my immune system so I ended up getting glandular fever and now I have chronic fatigue. Topamax is a drug for epilepsy that has to be reduced slowly or it can cause fits etc. I was not informed of its dangers when I was prescribed it two years ago, have been sick ever since till a natural path helped me. I haven’t had any migraines yet but I just started taking half of one of the .25mg clonidine tabs to help me sleep as I have severe sleep problems but have been waking with a headache and after reading these comments I don’t want to use it every night long term. Used to work well short term for migraine.. to help sleep.

    • Kay
      Reply

      My 11 yr old son recently started clonidine for ADHD. He was on seroquel, but the weight gain was alarming, so we tapered off of it & slowly added clonidine. This morning he reported seeing a man over his bed with a knife. Seems he was either hallucinating or having a nightmare. I instantly suspected a side effect of clonidine & will call the psychiatrist today to get him off of this drug.

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