- Epidural clonidine is more likely to be effective in patients with neuropathic pain than somatic or visceral pain
- Clonidine [Epidural] is not recommended for obstetrical, postpartum, or perioperative pain (due to risk of hypotension and bradycardia)
- Clonidine decreases sympathetic outflow from the central nervous system resulting in decreases in peripheral resistance, renal vascular resistance, HR and BP
- Monitor vital signs frequently, especially during the first few days of therapy. Severe hypotension may occur following clonidine administration. Use with extreme caution in patients with hemodynamic instability, hypotension, cardiovascular disease
- Reduce dose over 2-4 days to avoid withdrawal symptoms. Sudden cessation has resulted in nervousness, agitation, headache, and tremor, accompanied or followed by a rapid rise in blood pressure. Increased risk of withdrawal symptoms if concomitant beta blocker therapy is administered. Discontinue beta-blocker several days before the gradual discontinuation of epidural clonidine
- Monitor creatinine at baseline
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Cerebrovascular disease
- Cardiovascular disease
- Cardiac conduction defects
- Recent MI
- Hx of depression
- Hemodynamically unstable patients
Pregnancy Category:C
Breastfeeding: Excreted in breastmilk. Clonidine concentrations in human breast milk are ~ twice those found in maternal plasma. Due to the high serum levels in breastfed infants, other agents might be preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 15 July 2010).
