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.”


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. Joan

    I am getting BP spikes trying to get off of a clonidine patch 0.1 mg patch. Any ideas? Was blocking parts of it with tape. It is not supposed to happen. Other meds tried with it not helping and causing even more side effects (very side effect sensitive). Eg, I may have developed a bladder?/urinary problem which contributes to the spikes. It is slowly being investigated also. Everyone I see has a different idea. Been on the patch for about 7 weeks. Took it to lower BP for breast cancer surgery – it didn’t really work.

  2. kwain

    I have read a lot of negative things about Clonidine and I will agree, there are side effects. For me, it has been a blessing on multiple levels. I have tried many other blood pressure medications and they all have caused me severe joint pain and back pain as well other unacceptable side effects which greatly impacted my quality of life. I cannot even take a diuretic.

    As a last resort, my doctor put me on Clonidine. I have been on it for several years now. I deal with the tired feeling, dry eyes and occasional brain fog because this is far more preferable to constant pain and the impact it has on my daily life. I have also suffered from severe anxiety for years and Clonidine has been very effective for that as well.

    I do not take any other medication for anxiety. It even suppresses my hot flashes from menopause. Sadly, I cannot use the patch due to issues with skin irritation so I do experience peaks and valleys with my bp in between doses. I push through the tired feeling by doing and it does pass. I haven’t had any nightmares or other sleep disturbances, quite the contrary…it helps me get to sleep at night.

    I do experience a great deal of frustration when I have to see a new doctor because the first thing they want to do is take me off the Clonidine and try something else. Been there, done that and I don’t need the months of pain and trial and error and then end up where I started..on Clonidine. For me, if it works, quit trying to fix it.

  3. JS
    pacific nw

    I would like to know how to use clonidine patch safely with underlying sinus bradycardia. I am using it prn for spikes, but considering the 0.1 patch to achieve better constant control. My problem is the bradycardia which is usually about 48-52 bpm. I need to know approximately how much drop in pulse I can expect with a 0.1 patch.

  4. Laura

    I’ve been on clonidine for over 6 years for Dysautonomia /POTS to manage my heart rate. I’ve always done fine with it. But one day a week ago I woke up and have been in full autonomic dysfunction chaos every since. Heart rate erratic from 40s to 100s, dizziness, headaches, GI issues, full body symptoms.

    My cardiologist believes it’s from some rebound that can sometimes happen years after being on the medicine. We’ve lowered my dose, have seen a hair of the erratic improve, but everything is still wrong. I came here hoping to find anyone else who had suddenly had side effects, rebound, years into taking it. But haven’t seemed to find any info about this.

  5. Peter Ronman

    Took .1 mg of clonidine for jet lag on a trip to eastern Europe. Helped my bp so I continued to take it for 3 weeks at night. Took a great 2 hour hike in snow. Felt great till the end of the hike. Both calves swelled up. Tapepered off in 3 days. But if I walk, they swell up again. Its been 11 days now.
    When will this end?

  6. Mr. Jessup

    I made a horrible choice and ended up trying to commit suicide by overdosing:
    I went on a hike in woods in a remote area late in the afternoon, I took sixty .01 tablets, thinking that would stop my heart….but no…..but instead of dying, I merely lost consciousness. I “woke up” many hours later, in the dark, and lost in the woods.

    The ONLY symptoms were severe hallucinations and weakness in my arms and legs. My legs were so badly weakened that I could barely walk; I was stumbling, falling down hills over and over – unable to function.
    Although I was in the vastness of hundreds of miles of woods in the middle of the night, at one point I thought I was in a cabin, so took off my shoes to get into bed, but then wanted to go the small deli next to the Ranger station (there are no manmade structures anywhere in the area) and left my backpack (with my phone, blanket, pillow, cell phone, water, etc.) to start “walking” unable to balance – I ended up going over a sheer cliff, sliding down into mud, rocks and brush, tearing my skin and leaving me bruised, battered and cut up from head to toe.

    I couldn’t make sense of anything – and I thought there were people nearby, a man asking me questions and a lady walking her dog and talking on her cell phone- as I am barely hanging on to the side of this mountain. I kept hearing people talking, like these two guys discussing how they just got off work late and were taking a stroll in the woods, and I would look over and see three clocks, two digital and one second hand, each different times, wondering how it got so late as I kept trying to pull my blanket over me to keep me warm….I was freeing and still hearing/seeing things that made zero sense.

    I stayed in the woods for 48 hours till I found a way out.
    The entire situation was absolute INSANITY.
    Its been four days, the hallucinations stopped – but I am still so weak physically.
    Weird, I have never felt so wide awake, I haven’t been able to sleep since that day, maybe its just the shock.
    So they aren’t a good idea for checking out.

  7. Mike M.
    Northeast US

    I started taking Clonidine tabs several mo’s ago because I unexpectedly found out that I had very high bp. (sustained 201/123 plus), and have experienced MANY side effects from it. I was advised to take .01 (the lowest mg), and was upgraded to take .02.

    My bp kept spiking, and when I went to a diff dr. I found out more telling info. Clonidine works in 8 hr intervals, and after 6 or so hrs, it actually spikes your bp higher than it originally was, rebounding it up and down continuously ….

    I had very SERIOUS dry mouth, dry throat, a “nod” like I was on about to fall asleep where-ever I may be at, decreased sexual aspects, short term memory loss, dizziness to put me on a knee at times, agitation on borderline aggressiveness, to name some…..and I was never told you can’t stop it suddenly…. My PC dr now recently put me on Norvasc 10mg, but wanted me to continue with the Clonidine, which I did.

    The bp was still staying high and the side effects continued. Finally I just sought a new cardio dr for more advice, especially w/ these side effects.

    My new cardio dr continued the Norvasc 10mg and added Losartan/HCTZ 50-12.5, and discontinue the Clonidine at last. My bp is now staying level in the low 120’s now. My new cardio dr says he can’t figure why I was just kept on a .01 level dose of Clonidine daily,(especially with how high my bp was sustaining), and why it wasn’t prescribed with something else also.

  8. Angela
    Portland Or

    Clonadine saved my life. I was put on this medication for opiate withdrawl & it worked beautifully. I did experience dry mouth & nose & was pretty tired but it was well worth it to get off a 10 year opiate addiction.

    • Cal MD

      I think you mean .1 mg and .2 mg.
      This is a good site and it is important to be precise

  9. Ron

    does clonidine cause Alzheimer’s

    • Cal MD

      It can certainly cause brain fog and if your provider is unaware of this as known side effect, may make an erroneous Dx of Alzheimer’s

  10. Marie

    I have been on clonidine for about two years. At first I was taking it as needed for extremely High BP. My BP seems to rise for no reason, even in my sleep and this wakes me up. Now I take Clonidine 3 times a day. AM, Mid Day, & PM, before bed.
    I am tired all the time and find it difficult to walk anywhere, even to the mailbox. Sometimes I feel dizzy.

    It has a tendency to rebound on me and because of that my BP skyrockets. I just want to get off this medication to see if I can get my energy back. I’m scared to drive anyway for fear my BP will spike or drop too low. Its very unpredictable. I think I’ll cut them in half and taper off & see if I feel better.

  11. Dennis

    I’ve been on Clonidine for 5 years. I’m 70 y.o. I’m at the max dose right now (0.3 mg X 3) and have dry mouth and weakness. I take a diuretic, plus 2 other BP meds, so I have several side effects that slow me down. I overdosed on Clonidine once, mistakenly taking 2 tabs instead of 1 for my morning dose. The first effect was spiking BP, then about 4 or 5 hours later, I had hypotension (not severe). My cardiologist told me to skip my second tab, and then take my third tab at night. He said I would be OK. He was right. The next day, I felt better. We have discussed stopping Clonidine and taking another alpha-blocker that has fewer side effects and easier to manage (2 pills a day instead of 3 pills a day).

  12. K

    Clonidine was given to me for narcotics withdrawal, and at first I thought I was OK but then I had a terrible incident driving home from a trip. I stopped briefly at a store, and when I got out of the car to go inside, I totally got dizzy and basically fell into the ladies handicap stall, and my eye went right into the purse holder. I lost all control and looked like a complete drunk. I will never take that drug again.

  13. Tammy

    Clonidine sent my bp high, high, high over several days, and I ended up in the ER. They said I had AFUB. I think it was the Clonidine. Beware of this Clonidine. I am 67 and scared to death with the high bp. Will be getting a second opinion

  14. Amy

    I have been on Clonidine for around six years and have never experienced any side effects or problems at all from it. Just thought I would share that there are people out there that take it without any problems

  15. Marie

    My doctor put me on the Clonidine patch for hot flashes due to menopause. It’s definitely helping but the patch is a lot more expensive than the pills would be. Are the pills generally as effective as the patch for helping with hot flashes? I know a few people who have used the patch but nobody who has used pills for them.

  16. Dawn
    Madison, WI

    I began taking Clonidine about a week ago to ease withdrawal symptoms from long term fentanyl (VERY strong narcotic for those that aren’t familiar) :) for severe fibromyalgia and chronic back pain post-surgery. I knew it was normally used for high blood pressure as my mom was on it but I had no idea what kind of side effects it would have for me. I’ve experienced EVERY single side effect listed on this site!

    I’m only taking two 0.1mg tablets daily and I honestly feel like I’m starting to lose my mind! My head hurts constantly, my eyes, nose and mouth are totally dry which led to a couple sores in my nose. I also have Irritable bowel syndrome so I’m going back and forth between constipation and almost uncontrollable diarrhea. My vision is a sudden disaster. I feel like I can’t think straight-like my head is full and weighted. I’ve been forgetting to do things like shut faucets off and almost forgetting to close the door when my dog comes in. It’s all very scary and starting tomorrow I’m going to find a new doc and good, bad, or indifferent, I’m going to start to taper off this nasty drug. In my book it’s right in line with Prednisone, which I have charted that I absolutely should never be given that unless it’s to save my life. I believe this med is going on the same list.

    I CANNOT feel this way! Especially since I’m a Nanny and I care for a precious little boy who is a preemie and he has a few special needs so I need to be on my “A” game at all times.

    PLEASE! If you or an older loved one is taking this, talk to them about this!
    Thanks so much for the information!
    God bless!

  17. MJ
    New Mexico

    I had always heard good things about clonidine, and unexpectedly started to have high blood pressure. I’m 57, and always had nice lowish pressures except for when circumstances interfered. Stress related, is what I think. Anyway, my nurse practitioner put me on clonidine, which I really didn’t know was for bp. Thought it was mostly used for drug withdrawals. She said it would also help with anxiety. I took it for about a week, but then I just stopped. I think it might have worked nicely for sleep, maybe slightly help my anxiety, but I couldn’t live with the side effects. My heart beat so erratically, I almost called 911 several times. I know it was the clonidine, as nothing else had changed, and it stopped when I stopped taking it. Yep, pretty bad. I was surprised too. You wouldn’t necessarily think it would have an effect like that. But my heart would suddenly just start galloping too quickly, irregular beats, then feel like it would stop if I didn’t do something. I thought I had a heart issue! But after I stopped, that stopped. It was so scary, that was a horrible week. It was constant, and happened both day and night. My blood pressure must have dropped to normal levels again, because she didn’t put me on anything else, thank God. I was sort of disappointed though, because it could have been useful for those times when my pressure goes up or I’m anxious.

  18. susan

    I tried every other category of bp lowering drug and clonidine was the only one I could tolerate. I’ve been taking 0.150mg three times a day for 4 years. I’m 63. I get lots and lots of the known symptoms but 90% of them I had from peri and menopause before actually taking the drug. I also have unstable hip ligaments and the drug helps a lot with those symptoms. It controls my bp well except in the doctor’s office where it causes panic with the staff. Overall, I am happy to take the drug.

  19. Nitroman

    I’ve been on clonidine for about a year now for anxiety and high blood pressure. It has good and bad points …
    It has reduced my blood pressure and anxiety – due to adrenalin blocking effects, it also reduced sweating.

    It seems to have possibly decreased my mood (i’m prone to depression), it also reduced libido and can cause other sexual side effects. I also noticed that it impaired my memory … I’m trying to learn new language and it is easier when i miss a dose.
    Not sure it’s the ideal panacea to my condition, but may be useful for some.

  20. Cheryl

    My pdoc put me on the catapress PATCH 0.1mg – change weekly. This was prescribed to help the Adderall crash between doses. I’ve weaned off Prestiq a week ago & have been exhausted for months. I’ve also lost a ton of hair. I don’t know if it’s this med or stress etc.

  21. Mona

    I have been on Lamictal 2 years no problem, Valium 9 years no problem.
    I complained of slight agitation to my psych who said this will “help” with anger. I took one 0.1mg all at once and looked like I was nodding on heroin…. but to my understanding that is a baby dose and I do not have natural low nor high BP. I cut that in half and continued to try it. Even with my Valium I had bad anxiety and unable to focus the deralizatioion I already had got worse was like a slight LSD trip but without the fun. I was afraid to stand from dizzy/faint feeling. My anger grew wore and I felt like I haven’t sleep in ages and that was only 4 days on 0.1mg cut in half a day. -_- Whats odd to me is I have really high heartrate before the clonidine (120 to 115bpm) and the clonidine seems to make it worse? I thought it lowered heart rates? I am so confused an my psych want’s me to stay on (I think he plans to replace the Valium.) I am on a baby dose and have no idea why it is effecting my like this! What I REALLY wanted and hoped for this med to do was lower my heart rate :( I wish I new if I should ride it out and the heart rate lowers in weeks treatment or is it suppose to lower fast? the high heart rate and hot numb arms usually last the fist hour after the small half dose of the 0.1mg :/ I know nobody who takes this med to ask them questions and my psych thinks I am lying!

  22. Jake West
    New Jersey

    I had insulin diabetes and high blood pressure and I woke up one day with a sleepy foggy head that wouldn’t let up. I went to the ER and they said that I had a small stroke and put me on lisinapril, Norvasc and Clonidine. Weeks later I got very dizzy and went back to the hospital. 2 doctors said it was the stroke 2 doctors said it was the clonidine. After 1 1/2 years on these drugs, my BP went up so I doubled the dose, doctors advice,
    of the clonidine. I had the most vivid, lucid dream of my life! Everything was crystal clear and I knew I was dreaming. I woke up into another dream world, then another and another. Then finally woke up into my body on the bed.
    I oversleep by 3 hours. Strangest night of my life!

  23. Corine Merritt
    Houston, Texas

    Thank God I found this information regarding Clonidine. I went to the emergency clinic today because my blood pressure was elevating. I told the doctor that I was also having leg cramps. I took a tablet this morning and one before I went to bed. I went to bed at 12:a.m and woke up at 1:30 a.m. with leg cramps. I told that doctor I was having legs camps when I was at his office. I am 78 years old and he should have known better. What is wrong with these doctors………aren’t they required to know the side effects of medications they are prescribing? Thank you for this information.

  24. Rachel

    I take these tables, 0.1 x 3 a day, just stated taking two at night one in the morning, where it used to be the other way round.
    My memory has been terrible, feel like sleeping mid morning – but difficult at work.
    Bad skin rashes (hives) on the skin of my arms, blood pressure, not good, and the blood supply reaching my brain at a slower pace.
    No nightmares yet. and sleep very well.
    I will be making an appointment to come off these tablets, they should be a lot more research done in them.

  25. Christine
    Clarks Summit, Pa

    I have been on Clonidine for years. I don’t even remember when I started them. I take it at bedtime. It’s a 0.3 . I do know that I first started out with dry mouth, dizziness, very tired during the day. This continues even today. I have had a nightmare here and there during the years, but now I have been having them every single nite for about three weeks. They wake me up and I’m shaking and trembling in my bed. I also act out when sleeping such as screaming, talking and even becoming physical. My boyfriend has told me so. I’m at a point where I’m afraid to go to sleep! I will discuss continuing this med. with my doctor next week. Hope to resolve this madness.

  26. Kacie Lee

    I take 0.4 mg of clonidine & I am 15 years old. I have ADHD, so i take clonidone for sleep. Anyways, I experience light headedness, rashes, skin agitation, irregular heartbeat, Low sex drive, etc. When I don’t take my medicine for a day or two, I tend to shake really bad.. I feel like everything around me is fake… My anxiety is awful.

    • Laura

      What did you end up doing with the clonidine? I’ve been on it for 6 years and have done well until this week, it’s causing an uproar to my central nervous system, erratic heart rates.
      I’m looking for anyone else who suddenly had new side effects from this med after years on it.

  27. Bobbi

    I have headaches and a badd dry cough that make me throw up. I have been winging myself off this mess so that I won’t have to take it anymore, I have missed 3 days and then took one tablet on the 4th day and will repleat this again. This medicine is just not for me.

  28. I. Y. Domingo, Jr.

    I started taking Clonidine since 2010 and experienced dry mouth, awake at night and some joint and painful leg muscle cramps, headaches, blurred vision, back pains, are my symptoms and started having the same nightmares which was mentioned here in the forum.

  29. Jim
    Brevard, NC

    I’ve taken Clonidine for a number of years. Dry mouth, awake at night and possible joint cramps are my symptoms. I’m never confused and do not have strange dreams.

  30. Mildred H

    Mildred H. I’ve been on 0.1 MG TAB of Clonidine for several months. 2 at nite. 1 on rising. My Dr tried newer drugs. Very adverse reaction.
    I have stress related blood pressure, which is hard to treat. Since 1981 I have been on & off BP med probably 8 or more times.
    When stresses are dealt with and relieved, BP med overwhelms system to the point of my falling on bed when making it. Precarious spot to be in.
    My BP was at 220/110 w/ pulse at 111 when my son and I left for the funeral home. I had taken an extra BP med attempting to lower it. Mom, 2 days short of 94 lay in her coffin. Others stresses were also in play. This was on May 24th.
    Unexpectedly I spoke out to the congregation about my mom in a vet negative manner. I know this because of all the repercussions that have come against me since. I, myself do not remember any of the words I spoke, only the topics. They were Mental Health & Commitment to vows of marrive.
    Apparently I spoke my mind on both subjects.
    This speaking out has carried horrible emotional upheaval in me.
    I’m very interested in knowing that answer to these questions.
    Thanks. Mildred H. June 9, 2016.

    • Terry Graedon

      We don’t know if the clonidine caused your atypical behavior. Overdosing (the extra dose) can cause blood pressure to go up at first, and then drop precipitously. Hallucinations may occur. Here are the psychological side effects of clonidine, according to DailyMed: “Agitation, anxiety, delirium, delusional perception, hallucinations (including visual and auditory), insomnia, mental depression, nervousness, other behavioral changes, paresthesia, restlessness, sleep disorder, and vivid dreams or nightmares.”

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