Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents. Codeine; Promethazine: Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents. CoQ10 use in combination with antihypertensive agents may lead to additional reductions in blood pressure in some individuals.
Patients who choose to take CoQ10 concurrently with antihypertensive medications should receive periodic blood pressure monitoring.
Patients should be advised to inform their prescriber of their use of CoQ COMT inhibitors have also been associated with sudden sleep onset during activities of daily living such as driving, which has resulted in accidents in some cases. Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment.
Patients should be advised to avoid driving or other tasks requiring mental alertness until they know how the combination affects them.
Crizotinib: Major Avoid coadministration of crizotinib with agents known to cause bradycardia, such as clonidine, to the extent possible due to the risk of additive bradycardia. If concomitant use is unavoidable, monitor heart rate and blood pressure regularly. An interruption of crizotinib therapy or dose adjustment may be necessary if bradycardia occurs. Cyclobenzaprine: Moderate Cyclobenzaprine is structurally related to the tricyclic antidepressants and Clonidine's antihypertensive effect can be reduced by TCAs.
Caution is warranted when combining cyclobenzaprine with clonidine. Cyclosporine: Minor Clonidine can inhibit cyclosporine-induced glomerular vasoconstriction and has been shown to offset cyclosporine-induced nephrotoxicity. Clonidine may adversely affect cyclosporine pharmacokinetics; limited data suggest that cyclosporine concentrations increase - dramatically, in some cases - when clonidine is added.
Until more data are available, clinicians should use clonidine cautiously in patients stabilized on cyclosporine. Dapagliflozin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Dapagliflozin; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Dapagliflozin; Saxagliptin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Desipramine: Moderate If a patient receiving clonidine is also taking tricyclic antidepressants, the hypotensive effect of clonidine may be reduced, necessitating an increase in the clonidine dose. Desloratadine; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Deutetrabenazine: Moderate Concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as clonidine, may have additive effects and worsen drowsiness or sedation.
Advise patients about worsened somnolence and not to drive or perform other tasks requiring mental alertness until they know how deutetrabenazine affects them. Dexbrompheniramine; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Dextroamphetamine: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed in patients receiving clonidine and amphetamines. Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents Dextromethorphan; Diphenhydramine; Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine.
Dextromethorphan; Guaifenesin; Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine. Dextromethorphan; Guaifenesin; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Dextromethorphan; Quinidine: Moderate Quinidine can decrease blood pressure and should be used cautiously in patients receiving antihypertensive agents due to the potential for additive hypotension.
Diazoxide: Moderate Additive hypotensive effects can occur with the concomitant administration of diazoxide with other antihypertensive agents. The manufacturer advises that IV diazoxide should not be administered to patients within 6 hours of receiving other antihypertensive agents. Diazoxide can enhance the hyperglycemic, hyperuricemic and antihypertensive effects of thiazide diuretics.
Diclofenac: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Diclofenac; Misoprostol: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Diethylpropion: Major Sympathomimetics, such as diethylpropion, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Diflunisal: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Digitoxin: Moderate Clonidine can produce bradycardia and should be used cautiously in patients who are receiving other drugs that lower the heart rate such as cardiac glycosides. Digoxin: Moderate Clonidine can produce bradycardia and should be used cautiously in patients who are receiving other drugs that lower the heart rate such as cardiac glycosides.
Dihydrocodeine; Guaifenesin; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Diltiazem: Moderate Monitor heart rate in patients receiving concomitant clonidine and agents known to affect sinus node function or AV nodal conduction e. Complete AV block resulting in a nodal rhythm and sinus bradycardia resulting in hospitalization and pacemaker insertion have been reported during combination therapy of clonidine with diltiazem or verapamil.
Dipeptidyl Peptidase-4 Inhibitors: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Diphenhydramine; Hydrocodone; Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine.
Diphenhydramine; Ibuprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Diphenhydramine; Naproxen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Diphenhydramine; Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine. Dobutamine: Major Sympathomimetics, such as dobutamine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Dopamine: Major Sympathomimetics, such as dopamine, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Doxepin: Moderate If a patient receiving clonidine is also taking tricyclic antidepressants, the hypotensive effect of clonidine may be reduced, necessitating an increase in the clonidine dose.
Dulaglutide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Duloxetine: Moderate Orthostatic hypotension and syncope have been reported during duloxetine administration.
The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Monitor blood pressure if the combination is necessary. Empagliflozin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Empagliflozin; Linagliptin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Empagliflozin; Linagliptin; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Empagliflozin; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Enflurane: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Reduced dosages of antihypertensives may be required during heavy sedation. Ephedrine: Moderate Carefully monitor blood pressure in patients who have received both ephedrine and clonidine; clonidine augments the pressor effect of ephedrine.
Ephedrine; Guaifenesin: Moderate Carefully monitor blood pressure in patients who have received both ephedrine and clonidine; clonidine augments the pressor effect of ephedrine. Epinephrine: Moderate Clonidine may potentiate the pressor effects of epinephrine. Epoprostenol: Moderate The concomitant administration of epoprostenol with other antihypertensive agents can result in additive hypotensive effects.
This can be therapeutically advantageous, but dosages must be adjusted accordingly. Ertugliflozin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Ertugliflozin; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Ertugliflozin; Sitagliptin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Esketamine: Major Closely monitor patients receiving esketamine and clonidine for sedation and other CNS depressant effects. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep.
Estradiol Cypionate; Medroxyprogesterone: Minor Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormone therapy should be monitored for antihypertensive effectiveness. Estradiol: Minor Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormone therapy should be monitored for antihypertensive effectiveness.
Ethanol: Major Advise patients to avoid or limit alcohol use while taking clonidine. Clonidine may potentiate the CNS-depressive effects of alcohol. Watch for an enhancement of hypotensive effects as well as orthostatic hypotension, dizziness, or fatigue may be induced or exacerbated. Etodolac: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Etomidate: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Exenatide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Famotidine; Ibuprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Fenfluramine: Moderate Monitor for excessive sedation and somnolence during coadministration of fenfluramine and clonidine. Fenoprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Fexofenadine; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
It is possible that additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents. Fluphenazine: Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents. Flurbiprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Fospropofol: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Gabapentin: Major Initiate gabapentin at the lowest recommended dose and monitor patients for symptoms of sedation and somnolence during coadministration of gabapentin and clonidine.
Concomitant use of gabapentin with clonidine may cause additive CNS depression. Educate patients about the risks and symptoms of excessive CNS depression. General anesthetics: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
Glipizide; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Glyburide; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Guaifenesin; Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine. Guaifenesin; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Haloperidol: Moderate Disturbances of orthostatic regulation e. Also, based on observations in patients in a state of alcoholic delirium, high intravenous doses of clonidine may increase the arrhythmogenic potential QT prolongation, ventricular fibrillation of high intravenous doses of haloperidol.
A causal relationship and relevance for clonidine oral tablets have not been established. Halothane: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Hydralazine; Isosorbide Dinitrate, ISDN: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Hydrocodone; Ibuprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Hydrocodone; Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Hydrocodone; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Ibuprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Ibuprofen; Oxycodone: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Ibuprofen; Pseudoephedrine: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Iloperidone: Moderate Secondary to alpha-blockade, iloperidone can produce vasodilation that may result in additive effects during concurrent use with antihypertensive agents.
If concurrent use of iloperidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position. Iloprost: Moderate Further reductions in blood pressure may occur when inhaled iloprost is administered to patients receiving other antihypertensive agents.
Imipramine: Moderate If a patient receiving clonidine is also taking tricyclic antidepressants, the hypotensive effect of clonidine may be reduced, necessitating an increase in the clonidine dose. Incretin Mimetics: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Indomethacin: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Insulin Degludec; Liraglutide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Insulin Glargine; Lixisenatide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Insulins: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Intravenous Lipid Emulsions: Moderate High doses of fish oil supplements may produce a blood pressure lowering effect.
Isoflurane: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Isoproterenol: Major Sympathomimetics can antagonize the antihypertensive effects of clonidine when administered concomitantly. Isosorbide Dinitrate, ISDN: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Isosorbide Mononitrate: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Ketamine: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Ketoprofen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Ketorolac: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Lansoprazole; Naproxen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Lasmiditan: Moderate Monitor for excessive sedation and somnolence during coadministration of lasmiditan and clonidine. Additionally, monitor heart rate if lasmiditan is coadministered with clonidine as concurrent use may increase the risk for bradycardia. Lasmiditan has been associated with lowering of heart rate.
In a drug interaction study, addition of a single mg dose of lasmiditan to another heart rate lowering drug decreased heart rate by an additional 5 beats per minute. Lemborexant: Moderate Monitor for excessive sedation and somnolence during coadministration of lemborexant and clonidine. Dosage adjustments of lemborexant and clonidine may be necessary when administered together because of potentially additive CNS effects. The risk of next-day impairment, including impaired driving, is increased if lemborexant is taken with other CNS depressants.
Levodopa: Moderate Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Levomilnacipran: Moderate Because levomilnacipran inhibits norepinephrine reuptake, coadministration with clonidine may inhibit clonidine's antihypertensive effect. Linagliptin; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Liraglutide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Lisdexamfetamine: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed in patients receiving clonidine and lisdexamfetamine. Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents. Lixisenatide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Lofexidine: Major Lofexidine is a central alpha-2 adrenergic agonist, and its effects can be additive to other medications in the same class. Monitor for excessive hypotension, bradycardia, and sedation during coadministration. Patients being given lofexidine in an outpatient setting should be capable of and instructed on self-monitoring for hypotension, orthostasis, bradycardia, and associated symptoms.
Loratadine; Pseudoephedrine: Moderate Sympathomimetics, such as pseudoephedrine, can antagonize the antihypertensive effects of clonidine when administered concomitantly. Lovastatin; Niacin: Moderate Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise.
Clonidine has been shown to inhibit niacin-induced flushing. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. Lumateperone: Moderate Monitor for excessive sedation, somnolence, and orthostatic hypotension during coadministration of lumateperone and clonidine. Concurrent use may result in additive CNS depression or orthostasis.
Lurasidone: Moderate Due to the antagonism of lurasidone at alpha-1 adrenergic receptors, the drug may enhance the hypotensive effects of alpha-blockers and other antihypertensive agents.
If concurrent use of lurasidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position.
Macimorelin: Major Avoid use of macimorelin with drugs that may transiently elevate growth hormone concentrations, such as clonidine.
Healthcare providers are advised to discontinue clonidine therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test.
Maprotiline: Major Concurrent use of clonidine with maprotiline should be avoided when possible, due to multiple possible interactions.
Clonidine's antihypertensive effect can be reduced by cyclic antidepressants, such as maprotiline. If coadministration of maprotiline with clonidine cannot be avoided, the patient should be closely monitored for increased blood pressure and clonidine dosages adjusted as needed. Meclofenamate Sodium: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Mefenamic Acid: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Meglitinides: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Meloxicam: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Meperidine; Promethazine: Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents.
Mesoridazine: Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents. Mestranol; Norethindrone: Minor Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients; monitor patients receiving concurrent therapy to confirm that the desired antihypertensive effect is being obtained. Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Metformin; Repaglinide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Metformin; Rosiglitazone: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Metformin; Saxagliptin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Metformin; Sitagliptin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Methamphetamine: Minor Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like clonidine, when clonidine is used for blood pressure control.
Close monitoring of blood pressure is advised. Methazolamide: Moderate The concomitant administration of diuretics with other antihypertensive agents can result in additive hypotensive effects. Methylphenidate Derivatives: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and clonidine, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including clonidine. Midodrine: Major Sympathomimetics can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Miglitol: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Milnacipran: Moderate Because milnacipran inhibits norepinephrine reuptake, coadministration with clonidine may inhibit clonidine's antihypertensive effect.
Milrinone: Moderate Concurrent administration of antihypertensive agents could lead to additive hypotension when administered with milrinone. Titrate milrinone dosage according to hemodynamic response. Mirtazapine: Moderate Monitor closely for loss of blood pressure control or other loss of effect of clonidine if these agents are used together. Mirtazapine and clonidine have pharmacologic actions that potentially oppose one another. Mirtazapine inhibits central alpha-2 autoreceptors located presynaptically on noradrenergic neurons and stimulating norepinephrine and stimulates the serotonergic system through antagonism at alpha-2 heteroreceptors.
Clonidine exerts its antihypertensive effect by stimulating the central alpha-2 autoreceptors, thereby causing a reduction in the synthesis and release of norepinephrine. Monoamine oxidase inhibitors: Contraindicated Monoamine oxidase inhibitors MAOIs may interact with antihypertensive medications.
If a patient receiving an MAOI is started on clonidine, severe hypertension may occur, and this reaction may be followed by hypotension, which may be severe. Additionally, if a patient is withdrawn from clonidine, an excess of circulating catecholamines may occur. The clinician should use these agents together with caution; blood pressure should be monitored frequently.
Nabilone: Major Monitor for excessive sedation and somnolence during coadministration of nabilone and clonidine. Nabumetone: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Naproxen: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Naproxen; Esomeprazole: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Naproxen; Pseudoephedrine: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Nateglinide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Nesiritide, BNP: Major The potential for hypotension may be increased when coadministering nesiritide with antihypertensive agents. Niacin, Niacinamide: Moderate Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. Niacin; Simvastatin: Moderate Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents.
Nitrates: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Nitroglycerin: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Nitroprusside: Moderate Additive hypotensive effects may occur when nitroprusside is used concomitantly with other antihypertensive agents. Dosages should be adjusted carefully, according to blood pressure. Nonsteroidal antiinflammatory drugs: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Norepinephrine: Major Sympathomimetics can antagonize the antihypertensive effects of clonidine when administered concomitantly. Nortriptyline: Moderate If a patient receiving clonidine is also taking tricyclic antidepressants, the hypotensive effect of clonidine may be reduced, necessitating an increase in the clonidine dose. Olanzapine: Moderate Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents. Olanzapine; Fluoxetine: Moderate Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents.
Olanzapine; Samidorphan: Moderate Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents. Opiate Agonists: Major Concomitant use of opioid agonists with clonidine may cause excessive sedation and somnolence. Limit the use of opioid pain medication with clonidine to only patients for whom alternative treatment options are inadequate.
If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Oxaprozin: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Oxymetazoline: Major The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by clonidine.
If these drugs are used together, closely monitor for changes in blood pressure. Paliperidone: Moderate Paliperidone may cause orthostatic hypotension, thereby enhancing the hypotensive effects of antihypertensive agents. Orthostatic vital signs should be monitored in patients receiving paliperidone and central-acting adrenergic agents who are susceptible to hypotension. Pentoxifylline: Moderate Pentoxifylline has been used concurrently with antihypertensive drugs beta blockers, diuretics without observed problems.
Small decreases in blood pressure have been observed in some patients treated with pentoxifylline; periodic systemic blood pressure monitoring is recommended for patients receiving concomitant antihypertensives. If indicated, dosage of the antihypertensive agents should be reduced. Perphenazine: Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents.
Perphenazine; Amitriptyline: Moderate If a patient receiving clonidine is also taking tricyclic antidepressants, the hypotensive effect of clonidine may be reduced, necessitating an increase in the clonidine dose. Phendimetrazine: Major Sympathomimetics can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Phenothiazines: Moderate Phenothiazines may produce alpha-adrenergic blockade and appear to have additive hypotensive or CNS effects when administered concurrently with central-acting adrenergic agents. Phentermine: Major Sympathomimetics can antagonize the antihypertensive effects of clonidine when administered concomitantly. Phentermine; Topiramate: Major Sympathomimetics can antagonize the antihypertensive effects of clonidine when administered concomitantly.
Phenylephrine: Major The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by clonidine. Pimozide: Moderate Disturbances of orthostatic regulation e.
Caution patients to avoid hazardous tasks, such as driving or operating machinery, until the effects of concurrent use are known. Also, based on observations in patients in a state of alcoholic delirium, it has been suggested that high intravenous doses of clonidine may increase the arrhythmogenic potential QT prolongation, ventricular fibrillation of high intravenous doses of haloperidol.
Pioglitazone; Metformin: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Piroxicam: Moderate If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Ponesimod: Major Avoid concomitant use of ponesimod and medications that may decrease heart rate such as clonidine due to the risk for severe bradycardia and heart block.
Consider consultation from a cardiologist if concomitant use is necessary. Pramlintide: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Prazosin: Moderate Prazosin is well-known to produce a 'first-dose' phenomenon. Some patients develop significant hypotension shortly after administration of the first dose.
The first dose response acute postural hypotension of prazosin may be exaggerated in patients who are receiving beta-adrenergic blockers, diuretics, or other antihypertensive agents. Concomitant administration of prazosin with other antihypertensive agents is not prohibited, however. This can be therapeutically advantageous, but lower dosages of each agent should be used.
Metabolic: Gynecomastia or breast enlargement and weight gain. Musculoskeletal: Muscle or joint pain; and leg cramps. Ophthalmological: Blurred vision; burning of the eyes and dryness of the eyes. The most frequent which appear to be dose-related are dry mouth, occurring in about 40 of patients; drowsiness, about 33 in ; dizziness, about 16 in ; constipation and sedation, each about 10 in Body as a Whole: Fatigue, fever, headache, pallor, weakness, and withdrawal syndrome.
Cardiovascular: Bradycardia, congestive heart failure, electrocardiographic abnormalities i. Cases of sinus bradycardia and AV block have been reported, both with and without the use of concomitant digitalis.
Central Nervous System: 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.
Dermatological: Alopecia, angioneurotic edema, hives, pruritus, rash, and urticaria. Gastrointestinal: Abdominal pain, anorexia, constipation, hepatitis, malaise, mild transient abnormalities in liver function tests, nausea, parotitis, pseudo-obstruction including colonic pseudo-obstruction , salivary gland pain, and vomiting.
Genitourinary: Decreased sexual activity, difficulty in micturition, erectile dysfunction, loss of libido, nocturia, and urinary retention. Metabolic: Gynecomastia, transient elevation of blood glucose or serum creatine phosphokinase, and weight gain. Musculoskeletal: Leg cramps and muscle or joint pain. Oro-otolaryngeal: Dryness of the nasal mucosa.
Ophthalmological: Accommodation disorder, blurred vision, burning of the eyes, decreased lacrimation, and dryness of the eyes. Hypertension may develop early and may be followed by hypotension, bradycardia, respiratory depression, hypothermia, drowsiness, decreased or absent reflexes, weakness, irritability and miosis. The frequency of CNS depression may be higher in children than adults. Large overdoses may result in reversible cardiac conduction defects or dysrhythmias, apnea, coma and seizures.
Signs and symptoms of overdose generally occur within 30 minutes to two hours after exposure. As little as 0. After their removal, the plasma clonidine levels will persist for about 8 hours, then decline slowly over a period of several days.
There is no specific antidote for clonidine overdosage. Dialysis is not likely to significantly enhance the elimination of clonidine. This patient developed hypertension followed by hypotension, bradycardia, apnea, hallucinations, semicoma, and premature ventricular contractions. The patient fully recovered after intensive treatment. There have been rare reports of the need for patch changes prior to 7 days to maintain blood pressure control.
Therefore, gradual reduction of prior drug dosage is advised. Some or all previous antihypertensive treatment may have to be continued, particularly in patients with more severe forms of hypertension.
Patients with renal impairment may benefit from a lower initial dose. Patients should be carefully monitored. Since only a minimal amount of clonidine is removed during routine hemodialysis, there is no need to give supplemental clonidine following dialysis.
See chart below. Distributed by: Boehringer Ingelheim Pharmaceuticals, Inc. Address medical inquiries to: or TTY. Read the following instructions carefully before using this medication. If you have any questions, please consult with your doctor. It is designed to deliver the drug into the body through the skin smoothly and consistently for one full week.
During or even after use, a PATCH contains active medication which may be harmful to infants and children if accidentally applied or ingested. After use, fold in half with the sticky sides together. Dispose of carefully out of reach of children. Amitriptyline in combination with clonidine enhances the manifestation of corneal lesions in rats see Toxicology. In several studies with oral clonidine hydrochloride, a dose-dependent increase in the incidence and severity of spontaneous retinal degeneration was seen in albino rats treated for six months or longer.
Tissue distribution studies in dogs and monkeys showed a concentration of clonidine in the choroid. In view of the retinal degeneration seen in rats, eye examinations were performed during clinical trials in patients before, and periodically after, the start of clonidine therapy. In of these patients, the eye examinations were carried out over periods of 24 months or longer. In combination with amitriptyline, clonidine hydrochloride administration led to the development of corneal lesions in rats within 5 days.
There was no evidence of genotoxicity in the Ames test for mutagenicity or mouse micronucleus test for clastogenicity. Increased resorptions were not associated with treatment at the same or at higher dose levels up to 3 times the oral MRDHD when the dams were treated on gestation days 6 to Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Safety and effectiveness in pediatric patients have not been established in adequate and well-controlled trials. Most systemic adverse effects during Catapres-TTS transdermal therapeutic system therapy have been mild and have tended to diminish with continued therapy. Other skin reactions were localized vesiculation 7 patients , hyperpigmentation 5 , edema 3 , excoriation 3 , burning 3 , papules 1 , throbbing 1 , blanching 1 , and a generalized macular rash 1.
In additional clinical experience, contact dermatitis resulting in treatment discontinuation was observed in of patients about 19 in after a mean duration of treatment of 37 weeks. The incidence of contact dermatitis was about 34 in among white women, about 18 in in white men, about 14 in in black women, and approximately 8 in in black men. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate reliably their frequency or establish a causal relationship to drug exposure.
Decisions to include these reactions in labeling are typically based on one or more of the following factors: 1 seriousness of the reaction, 2 frequency of reporting, or 3 strength of causal connection to CATAPRES-TTS transdermal therapeutic system.
Body as a Whole: Fever; malaise; weakness; pallor; and withdrawal syndrome. Cardiovascular: Congestive heart failure; cerebrovascular accident; electrocardiographic abnormalities i. Dermatological: Angioneurotic edema; localized or generalized rash; hives; urticaria; contact dermatitis; pruritus; alopecia; and localized hypo or hyper pigmentation. Genitourinary: Difficult micturition; loss of libido; and decreased sexual activity. Metabolic: Gynecomastia or breast enlargement and weight gain.
Musculoskeletal: Muscle or joint pain; and leg cramps. Ophthalmological: Blurred vision; burning of the eyes and dryness of the eyes.
The most frequent which appear to be dose-related are dry mouth, occurring in about 40 of patients; drowsiness, about 33 in ; dizziness, about 16 in ; constipation and sedation, each about 10 in Body as a Whole: Fatigue, fever, headache, pallor, weakness, and withdrawal syndrome. Cardiovascular: Bradycardia, congestive heart failure, electrocardiographic abnormalities i. Cases of sinus bradycardia and AV block have been reported, both with and without the use of concomitant digitalis.
Central Nervous System: 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.
Dermatological: Alopecia, angioneurotic edema, hives, pruritus, rash, and urticaria. Gastrointestinal: Abdominal pain, anorexia, constipation, hepatitis, malaise, mild transient abnormalities in liver function tests, nausea, parotitis, pseudo-obstruction including colonic pseudo-obstruction , salivary gland pain, and vomiting.
Genitourinary: Decreased sexual activity, difficulty in micturition, erectile dysfunction, loss of libido, nocturia, and urinary retention. Metabolic: Gynecomastia, transient elevation of blood glucose or serum creatine phosphokinase, and weight gain. Musculoskeletal: Leg cramps and muscle or joint pain.
Oro-otolaryngeal: Dryness of the nasal mucosa. Ophthalmological: Accommodation disorder, blurred vision, burning of the eyes, decreased lacrimation, and dryness of the eyes. Hypertension may develop early and may be followed by hypotension, bradycardia, respiratory depression, hypothermia, drowsiness, decreased or absent reflexes, weakness, irritability and miosis.
The frequency of CNS depression may be higher in children than adults. Large overdoses may result in reversible cardiac conduction defects or dysrhythmias, apnea, coma and seizures. Signs and symptoms of overdose generally occur within 30 minutes to two hours after exposure. As little as 0. After their removal, the plasma clonidine levels will persist for about 8 hours, then decline slowly over a period of several days.
There is no specific antidote for clonidine overdosage. Dialysis is not likely to significantly enhance the elimination of clonidine.
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