Usually, people go for the traditional drugs for Opiate withdrawal like Naloxone and Naltrexone, but now people have discovered various other medications for Opiate withdrawal.
One of these drugs is Clonidine. It is the drug of choice for hypertension and attention deficit hyperactivity disorder (ADHD), but now people take it for Opiate withdrawal too.
In this article, we will understand how clonidine can help with Opiate withdrawal, its mechanism of action, duration of action, dosage, contraindications, and complications. Let’s have a look at the article.
What is Clonidine?
It also helps in ailments like a migraine, diarrhea, menopausal flushing and chronic pain. It is an alpha2 adrenergic agonist as well as imidazoline receptor agonist.
It stimulates the alpha2 receptors, and this helps in decreasing the peripheral vascular resistance, thus lowering blood pressure.
This is achieved as the binding of clonidine to alpha2 receptors inhibits the release of norepinephrine which is responsible for vasoconstriction and elevation of systemic blood pressure.
It increases the noradrenergic tone of the prefrontal cortex, and this is how it alleviates the symptoms of ADHD.
What is Opiate withdrawal?
Frequent consumption of large doses of Opiates results in Opiate addiction.
This occurs as the body gets accustomed to the exogenous supply of Opiates and for its normal functioning it requires a continuous supply of Opiates.
If the Opiates are not taken, the body goes into a state of withdrawal. Opiate withdrawal occurs due to sudden cessation of Opiates leading to specific complications.
Now that we know that the body is dependent on Opiates which means it will only produce dopamine, serotonin and sympathetic neurotransmitters in the presence of Opiates, the person starts experiencing symptoms.
No dopamine means the person will feel low. No enkephalins, endorphins, and dynorphins mean he will begin to have cramps and pain. No sympathetic discharge means lethargy and easy fatigability.
The patient presents with a complaint of constipation, aggression, runny nose, irritability, depression and increased lacrimation.
How does, Clonidine help with Opiate withdrawal?
Clonidine is not a narcotic. It acts by reducing the noradrenergic hyperactivity that is associated with Opiate withdrawal. It alleviates the symptoms of anxiety and agitation.
It doesn’t mitigate cravings for Opiates. It also helps in reducing muscle cramps, sweating and runny nose. It helps in lowering the Opiate withdrawal symptoms without causing tolerance or dependence.
During the Opiate withdrawal phase, the patient experiences both physical and psychological symptoms which can be alleviated by clonidine without extending the detox period from more than two weeks.
This is in contrast to methadone and buprenorphine which continue the detox process. Clonidine acts by lowering heart and blood pressure thus reducing the sensation of anxiety and improving attention.
It suppresses impulsivity and enhances mood. Clonidine, however, is not effective in treating withdrawal symptoms like muscle aches, insomnia and physical craving for Opiates.
Before taking Clonidine
Ensure that you take all the necessary cautions before taking Clonidine for Opiate withdrawal. These include the following;
- Ensure you have no cardiovascular disorders.
- Ensure you don’t have a history of fainting spells or hypotension.
- Ensure that you have no history of myocardial infarction or stroke.
- Ensure you do not have pheochromocytoma (adrenal gland neoplasia)
- Ensure your Renal system is functioning properly.
- Ensure you do not have an allergy to Clonidine by performing the skin patch test.
- Do not take it if you are pregnant or lactating.
How to take Clonidine for Opiate Withdrawal?
It is taken twice a day for Opiate withdrawal, and it can be taken with or without food. Do not use two form of clonidine at the same time for Opiate withdrawal.
Do not crush or break or chew the tablet, just swallow it whole. Gradually taper the dose of clonidine if you experience adverse effects.
It can also be taken by injection or absorption through the skin. In the case of skin, a transdermal patch is placed for seven days.
A dose of 0.1-0.3mg of Clonidine is the oral dose for Opiate withdrawal, and this dose can be taken every six hours.
How much Clonidine should I take for Opiate withdrawal?
Clonidine is the drug that is approved by the FDA. It is available in the doses of 0.1mg, 0.2mg, and 0.3mg. It is also available in the form of skin patches and injectables.
An Opiate user can take a dose of 0.5mg to 1.4mg per day for Opiate withdrawal depending on his need.
Peak clonidine doses are administered on the second, third and fourth day. The daily regimen of oral Clonidine dosage is stated below;
Day 1: 0.1 to 0.2mg of oral clonidine every 4 hours. Total clonidine intake per day=1mg
Day 2 to Day 4: 0.1 to 0.2mg of oral clonidine every 4 hours. Total clonidine intake per day=1.2mg
Day 5 to completion of detox process: Reduce your dose 0.2mg daily. The night time dose should be reduced at last.
If you are using Clonidine patch you can use any of the three types; #1, #2 and #3. It delivers clonidine over a period of 1 week. #2 patch is equal to 0.2mg oral clonidine.
If the patient is under 100lbs apply one #2 patch. If the patient is over 100lbs, use #2 two patches and if the patient is over 200lbs apply #2 three patches.
On day one when the patch is applied, a dose of 0.2mg of oral clonidine is required after every 6 hours in the first 24 hours and a dose of 0.1mg after every 6 hours in the second 24 hours.
What does research say about the use of Clonidine for Opiate withdrawal?
Many studies suggest that Clonidine helps in Opiate withdrawal. A study conducted in 1980, titled as Efficacy of Clonidine in Opiate withdrawal:
A review of thirty patients states that clonidine can reverse and suppress the signs and symptoms of Opiate withdrawal.
The study was a double-blind crossover, placebo-controlled trial in thirty hospitalized Opiate addicts was given clonidine and studied. The results were successful. All thirty patients got detoxified entirely.
What are the side effects of Clonidine?
Some of the commonly occurring side effects of clonidine are dry mouth, headache, weakness, fatigue, tiredness, nausea, and vomiting, nervousness and constipation.
If these side effects become severe or complicated, you must consult a doctor.
Acute adverse effects of clonidine include swelling of the lips, tongue, throat, face including eyes, lower legs, ankle, and feet. These side effects are more pronounced in those who are chronic alcoholics.
Frequently asked questions
How does clonidine manage the Opiate withdrawal symptoms?
Some of the Opiate withdrawal symptoms with their management are mentioned below;
- Agitation: Clonidine helps in counteracting the hyperactivity of CNS that results in agitation.
- Anxiety: This is the rebound effect seen when the nervous system becomes hyperactive after detoxification. Clonidine suppresses these hyperactive states.
- Cognition deficits: These are removed because Clonidine acts as non-stimulant medication that increases the noradrenergic tone of the prefrontal cortex and improves cognition and alleviates impaired attention.
- Diarrhea: Studies suggest that clonidine reduces stool frequency and volume.
- Flushing: Controlled by clonidine as it regulates the vasomotor tone of the blood vessels.
- Mood swings: Clonidine helps in stabilizing mood.
Is clonidine safe?
If taken in the doses mentioned above, it is entirely safe.
Can I take clonidine with other medications?
No, you cannot as it may cause adverse drug interactions. Therefore, you must consult your doctor if you are taking medications for ailments like a migraine, hypertension, cardiac disorders, renal disorders or even GIT disorders.