Clonidine hydrochloride

CLINICAL USE

Hypertension Migraine Gilles de la Tourette syndrome Menopausal flushing

DOSE IN NORMAL RENAL FUNCTION

Hypertension: 50–100 mcg 3 times a day, increasing gradually to 1.2 mg dailySlow IV: 150–300 mcg; maximum 750 mcg in 24 hoursMigraine, menopausal flushing, Gilles de la Tourette syndrome: 50–75 mcg twice daily

PHARMACOKINETICS

Molecular weight :266.6

%Protein binding :30–40

%Excreted unchanged in urine : 40–60

Volume of distribution (L/kg) :3–6

half-life – normal/ESRD (hrs) :

10 to 20

/41

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAntidepressants: tricyclics antagonise hypotensive effect and also increase risk of hypertension on clonidine withdrawal; increased hypotensive effect with MAOIsBeta-adrenoreceptor antagonists: increased risk of hypertension on withdrawalCiclosporin: may increase ciclosporin levelsSympathomimetics: possibly increased risk of hypertension with adrenaline and noradrenaline; serious adverse effects reported with methylphenidate

ADMINISTRATION

Reconstition

–

Route

Oral, IV

Rate of Administration

Slow IV injection

Comments

Minimum volume for infusion 6–50 mcg/ mL in sodium chloride 0.9% or glucose 5% (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)

OTHER INFORMATION

Use in renal impairment: clonidine plasma concentrations for a given dose are 2–3 times higher in patients with severe renal impairment; however, blood pressure control appears satisfactory and adverse effects are not increasedClonidine withdrawal: rebound hypertension if drug is abruptly withdrawnTricyclic antidepressants may decrease efficacy

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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