Clonidine patch for opioid withdrawl?

CodeteamB · May 16, 2013

Caveat: I have an extremely basic understanding of this, I'm sure someone else can explain it a little better but here goes.

Here is how I understand it: basically opioid addicts have long term CNS suppression by their drug of choice, too many downers so the response to normal stimuli is really reduced. When the opioids are withdrawn the adrenergic system goes into overdrive and normal stimuli cause an abnormally high response (your jitters sweats and shakes). Clonidine decreases blood pressure by working on adrenergic receptors to decrease CNS excitation and thereby cardiac output... So the same action helps the patient in withdrawal.

The first time I saw clonidine ordered for withdrawal I was really surprised, but it's a fairly common order in my neck of the woods and from what I have seen it works pretty well.

SweetMelissaRN · May 17, 2013

Caveat: I have an extremely basic understanding of this, I'm sure someone else can explain it a little better but here goes.
Here is how I understand it: basically opioid addicts have long term CNS suppression by their drug of choice, too many downers so the response to normal stimuli is really reduced. When the opioids are withdrawn the adrenergic system goes into overdrive and normal stimuli cause an abnormally high response (your jitters sweats and shakes). Clonidine decreases blood pressure by working on adrenergic receptors to decrease CNS excitation and thereby cardiac output... So the same action helps the patient in withdrawal.
The first time I saw clonidine ordered for withdrawal I was really surprised, but it's a fairly common order in my neck of the woods and from what I have seen it works pretty well.

Ohhhhh! That makes so much sense... Almost makes me wonder why some people are on methadone regimens for opioid withdrawal when this is a much less addictive route? Is this use of clonidine fairly new?

CodeteamB · May 17, 2013

With a little research I found a study from 1980, so not too recent

I imagine methadone is a lot more popular for obvious reasons, but maybe that is my over-cynical nightshift self speaking.

I would be interested to hear from nurses who work in rehab about whether clonidine is used a lot in longer term or if it is just an ER "treat 'em and street 'em" quick fix. I have no experience with longer term detox.

Sassy5d · May 17, 2013

My initial thought was what happens when pt's are withdrawing and I thought of the Bp going up, up, up. I didn't think all the other stuff but makes sense

hodgieRN · May 17, 2013

With metadone, they can reduce the dosage over time and wean off. If a pt just gets clonidine, they still go through full blown withdraw, but the symptoms are reduced (less adrenergic stimulation). Clonidine is also a kind of depressant. Not only does it reduce blood pressure or decrease the effects of withdraw, it's also used for a bunch of off-label reasons. Pts who simply have insomnia can get clonidine for sleep. If you have a pt in the hospital that was just prescribed PO clonidine, they will seem sleepy or take lots of naps until their body gets use to it. I had a stroke pt who was very sleepy compared to prior days and I saw that one doc order clonidine for the BP. It was discontinued and he became more alert a day or two after. Believe it or not, it also has pain relief qualities. Pts with neuropathic pain can use it as an adjunct if their current regimen isn't giving full relief. Clonidine is also used for ADHD, OCD, Tourette's syndrome, PTSD, migraines, anxiety, and restless leg syndrome. All of this is related to the adrenergic agonist effects and it's ability to inhibit the body's production of norepinephrine and epinephine.

There's some very cool things about pharmacology. We concentrate so much on the a name of a drug and what it's used for. But, if you can look past that and concentrate on pharmacotherapeutic classification and the actual mechanism of action, you get to see things in a broader picture.

XmasShopperRN, ASN, RN · May 17, 2013

Interestingly enough, because of its sedative properties, clonidine actually has street value.