Clonidine
Clonidine, an alpha2-adrenergic agonist, is a centrally acting antihypertensive drug. It is used in neuropathic pain in combination with opioids and local anaesthetics, usually via intrathecal administration. The oral and subcutaneous routes can also be used. It is also used in the treatment of Tourette syndrome and to control autonomic symptoms of opioid withdrawal.
Clonidine acts directly on alpha2 adrenoceptors. It is well absorbed from the gut, with prompt onset of action. The half-life and the duration of action are both approximately 12 hours. A parenteral formulation is available.
Sedation and dry mouth are common adverse effects of clonidine. Abrupt withdrawal of clonidine can be associated with sympathetic overactivity, with tremor, sweating and hypertension occurring 12 to 36 hours after the last dose. It should be withdrawn gradually, over at least seven days
For neuropathic pain, consultation with a palliative care specialist, a pain physician, or a pain clinic is recommended before using clonidine.
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