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Clonidine (Catapres) Side Effects & Complications

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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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17 Comments

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I was prescribed clonidine in the mid 1980's to help with smoking cessation. Within a few days, I "woke up" on the side of the road, in my car I was driving alone & found I had a very low pulse rate of 42. I guess I passed out. Very lucky I didn't get killed. Anyway, I stopped the clonidine. My pulse rate recovered & I was fine. Very scary.

I am a 68 yr old female and have been taking an average of 3 pills a day. I monitor my blood pressure several times a day to determine if and when I should take a dose.

This has worked well for me for about 6 months, However, my dostolic reading is much harder to lower than the top number.

The pill makes me sleepy often, but is not normally a problem, as I just take a nap.
However, forgetting simple words is a problem very often. I usually just find another one to substitute for the one I have forgotten. lol

I depend on the drug to stay alive at this point, so I have no plans to stop it.

As a side note: I have an irregular heartbeat and have problems with the blood pressure cuff on my arm. I use a wrist blood pressure cuff and have had not problem with getting accurate readings. I have shared this hint with many friends because they could not get a good reading with the regular arm cuff.
I thought your readers would profit from this knowledge.

I look forward to your e-mails and you are the only source I have complete confidence in.
Keep up the great information.

My Dr prescribed lisinopril for my moderate very salt sensitive hypertension. It has worked well. I do get random sudden episodes of high BP 180/95 or thereabouts. For this, he prescribed clonidine...1 Tab- for these scary episodes which brings the BP down in 15 minutes.

I may only have to do this twice a month as I am cautious. I have had no side effects using it in this manner.

May I suggest that when your readers/visitors make comments or ask about their experiences and conditions, they indicate their AGE and GENDER. This would be most helpful to other readers and to you (PP) when you respond to them. Perhaps PP could place an AGE and GENDER box to be checked in the online comment space for visitor's convenience and as a reminder. Thank you
for providing a valuable service to your readers. JCB

While in the hospital post-op from pacemaker & hand surgery, my husband (age 67) woke up in acute pain with an ^BP so the nurse gave him his 1st ever Clonidine, and an oral analgesic. Within 45 minutes he was vomiting. He never had a reaction of this sort with any analgesic before or since. He put this drug on his "avoid" lost.

I am an 87 year old female and have been using a clonidine trans. patch for 2 years. I change it every week. So far I have noticed very few side effects. I do often wake up with a dry mouth and avoid constipation by eating lots of fiber. I was not aware of all the side effects that were connected with the drug. I take a nap frequently and have not noticed any confusion.

I am going to ask my Dr. if I should continue taking the drug as apparently it is not recommended for elderly folks. I also use a wrist cuff and my blood pressure is OK. That is why I am taking Cloidine - for high blood pressure.


I am a 63 old female, I was taking clondine tablets 60 mg twice a day, for 3 years. This drug gave me dry eyes and dry mouth.

The dry mouth was so bad that it led to many dental and other mouth problems. It was a moderate success for blood pressure. I finally had enough problems with my mouth (burning tongue syndrome) and many dental issues that the doctor changed my blood pressure medicine. I will never take this drug again.

I have been using the Catapres patch for terrible hot flashes for several years. Apparently it is also helping with my blood pressure. My doctor says the clonidine pill is not a very effective blood pressure medication but the patch is. I'm 72 and under treatment for metastatic breast cancer with a hormonal therapy that totally blocks estrogen. The patch is the one of only two medications that have worked to make life bearable. The other is Effexor, but I will never take that again. It also has bad side effects and tapering off of it made me nearly psychotic. The patch has truly been a life saver for me.

just started using the patch for moderately high blood pressure. so far having some side effects. nausea, some stomach discomfort, light headed, get tired easily, etc. only been on it 2 days so will see how it goes.

Don't do well with meds.

I've been on Clonidine - 0.1 mg, 3 times per day for 1 1/2 years for high BP. My side effects include dry mouth which has led to some dental gum issues, namely dental gum surgery. I'm now using a dental mouth rinse called 'Biotene' which really helps with my dry mouth. Rinse your mouth with this before bedtime. It really does work well.

Other effects include sleepiness in the afternoons. I take one pill in the morning, another in the afternoon and the third one at bedtime. After I take the afternoon pill, I become very groggy. My heart rate fluctuates between 49 and 61.

I sometimes get heart palpitations and shortness of breath. Doctors are unsure is these symptoms are drug related or menopause related. It makes it difficult for them to diagnose with certainty but I know intuitively that the clonidine is causing most of these symptoms. My BP readings have only now started to level out.

My concern after doing some research is that this medication may cause glaucoma in some patients if one stays on it for a long period of time. Unfortunately, I don't tolerate medications very well and that's why I'm still on this drug.

It took me 9 BP medications to try before my doctor put me on clonidine - she did so only because the side effects from other BP meds were too severe. I'd like to come off of this medication though. Am seeing an internist tomorrow afternoon to discuss other equally effective high BP medications.

Does anyone know of another high BP medication that would be similar to clonidine in the category of CAA - central acting agonist. I'd be eager to hear if anyone out there has come off this drug and found another equally effective drug with easier to tolerate side effects. All the other meds gave me severe headaches.

Have been on .06 mg clonidine at night for over 5 years. Several times have forgotten to take it and wake up with nightmare, extremely bad headache (feels like my head is going to explode), low pulse of 40-42,and very high b/p (around 210/110). It usually takes me couple of days to recover. The times I have forgotten to take it, grandchildren were staying over for movie night and I'd set it aside for when I went to bed, since it makes me very sleepy. I'd end up forgetting it. Am on Procardia, doxazosin and carvedelol in addition to clonidine, and have had trouble finding b/p meds that work without adversely affecting my kidneys. Have fibromuscular dysplasia of renal arteries, cause of sometimes uncontrollable hypertension. Am female and 67. Would love to stop clonidine, but even reducing it by 1/2 pill(.01 mg) causes bad b/p spike. Have also had episodes of sleep paralysis but not sure if I was on clonidine then. In addition, have dry mouth, forgetfulness, fatigue and low irr. pulse. Was diagnosed with FMD in late 30's, so have been dealing with this for a long time.

I have been using clonidine for a few years now for treating the "severity" of nightmares. However I still have nightmares every night and every 2-3 days wake up disoriented, crying and depressed from some of the nightmares. This early morning for example: I woke my husband up crying and groaning. It took him approx a minute to wake me up. Then when I fell back asleep I had another one that woke me up at 8am. It was concerning a family situation (have those dreams frequently). I am afraid to sleep. I don't even know if the clonidine is working. I take the max dose recommended for nightmares. 0.02mg a night. I would like to be nightmare free. But I don't know of a medication. There is therapy for it but from what I read I'm terrified to face the situations that caused me to have PTSD.
Thanks for letting me post a comment.

Cindy aka Seriosly exhausted

I took Clonidine for ADHD symptoms from the age of 11 to about 21. It was prescribed to me in spite of having chronic low blood pressure and initially I was required to have ECG screenings once a month to monitor my heart.

It was very much a drug to calm my crazy mother who believed me to be the source of all her problems. As an adult, I never received an adequate explanation from any doctor as to why it would be prescribed under those circumstances. My ADHD symptoms were of the spacey nature, not of the wild and crazy symptoms you might expect from a person using clonidine for this purpose.

I had nightmares for years and they have stopped since around the time I stopped taking the medication. This is the first I have ever heard of clonidine being the cause. No wonder I had so much trouble sleeping - one of the many "reasons" it was prescribed to me in the first place.

I am already a very lethargic, low-energy person and this medication made it even worse. I was essentially a zombie for many years. I don't think it should ever be used for ADHD symptoms - or in my case ADD.

I am an 87 year old male and was given clonidine in the ER May 2013. My b/p had gone up and the nurse gave it without any information on bad side affects. My family doctor put me on the patch and I did fairly well except for dry mouth etc..

The patch irritated my skin so badly that I had to go back to an oral dose of .03. My doctor told me later to split them in half and take twice daily, 12 hours apart. Two weeks ago I was back in ER and the same med was given. A week later I went to my family doctor and because of extremely high b/p he increased the clonidine to.03 twice a day, 12 hours apart. Before the time to take it (@ an hour) my b/p goes up to 200/75, rapid hard heartbeat, and a feeling of anxiety and doom. I have begun having crazy dreams and so sleepy I sometimes can hardly function for an hour or so.

We are trying to find a way to get off the drug but my doctor has not found the right combination as yet. I am also taking hydralazine, lisinipril, for b/p and terazosin for enlarged prostate. If I had been informed of the terrible side effects I would never have taken it. I have never had problems with meds before. I hope to find a way to get off clonidine.

I just looked up this article and am so glad I did! I have been on colonodine for a while now, maybe 8-10 months or more. I have been having nightmares at least 3-4 times a week for a while now. They are very disturbing to say the lest. I have also been constipated for months and have to take a stools softener. When I asked my Dr. if any of my meds could cause this, she said NO.

However, after two disturbing dreams last night, I looked it up. I do NOT used drugs or alcohol, or take an "mood altering" drugs. My life is great, I am not in any kind of turmoil, so why the bad dreams! Lo and behold, I have found the culprit. I am going to wean myself off of them. Another thing about this drug, it brings your b.p. down for a bit, but then it rebounds back to high quickly. In my opinion this is a bad drug. Plus I am 67 years old, and this drug is on the Beers list of drugs to avoid if you are an older person. Damn! Sometimes I feel that the Drs are out to kill us faster than the disease!

I was in opiate withdrawal, put on originally .01 2 x's a day. My Internist upped the dosage to .02 4x's a day for a month now.

I no longer need this Clonidine, I suffer with low blood pressure to begin with.
I am having severe panic attacks, horrible insomnia, leg pain and muscle stiffness every time I try to lower the dose.

I am not able to walk unassisted due to how "jello" my legs are. This drug was supposed to help with opiate withdrawal, instead it has left me in a much worse condition withdrawing now off Clonidine itself, which in my opinion is worse as well as extremely dangerous.

I need to wean off properly, my internist is NOT very knowledgeable on Clonidine. (Yes, I know time for a new doctor).

Does anyone have ANY advice for me? I am a 45 yr. old single mother of two who has to get back to work. Any help would be greatly appreciated.

I was prescribed clonidine primarily for help with withdrawal from methadone. Works great. My dose is .2 mg three times a day. I have continued it for high blood pressure as well. It does keep it pretty stable. I'm not sure about what happens when I will go off of it, if I ever do. I've been taking it for two years now. I would like to know about the withdrawals from it..

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