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How Does Clonidine Help in Opiate Detox?

Clonidine is a medication approved by the Food and Drug Administration (FDA) to treat high blood pressure. It is sold under the brand names Catapres and Kapvay, and it is sometimes also used to treat symptoms of ADHD. By acting on alpha-agonist hypotensive agents, clonidine decreases heart rate and relaxes blood vessels, which allows blood to flow more freely and better oxygenate body systems. It can also relax the part of the brain that controls impulsivity and attention, which can help children with ADHD symptoms.

What Is Clonidine?

While clonidine does not have many FDA-approved uses, the medication is often used off label. The drug is prescribed to treat hot flashes, restless leg syndrome, Tourette’s syndrome, and opioid withdrawal. The drug is one of the few medications routinely used in opioid withdrawal that is not, itself, a full or partial opioid-agonist.

Since clonidine acts on impulsivity, attention, blood vessels, and heart rate, the drug has been shown to be effective in reducing the intensity of narcotic withdrawal symptoms. However, there are also side effects from the medication that should be considered before it is used to treat opioid withdrawal.

How Is Clonidine Used in Opioid Detox?

When a person stops taking opioid drugs, like heroin or OxyContin, they may experience withdrawal symptoms. These can vary in intensity, depending on how long the person struggled with opioid addiction and how much of the narcotic they took to get high. If opioid painkillers were taken as prescribed, side effects are likely to be minimal; however, struggling with addiction means that physical and psychological side effects will likely feel more intense. These symptoms are not life-threatening, but without medical supervision for detox, withdrawal can lead to relapse.

Even without medicines to ease withdrawal, these symptoms typically clear up in two weeks or less. Psychological cravings and anxiety may persist, but physical symptoms will disperse.
Opioid withdrawal symptoms include:

  • Agitation, irritability, anxiety, and panic attacks
  • Muscle aches and joint pain
  • Watery eyes, runny nose, and other symptoms that are similar to a cold or the flu
  • Sweating
  • Excessive yawning
  • Insomnia
  • Abdominal cramps, nausea, and diarrhea
  • Dilated pupils
  • Goosebumps

However, during the two weeks that a person is detoxing from narcotic drugs, both physical and psychological symptoms can feel intense. Clonidine helps to alleviate these symptoms without extending the detox period, which maintenance therapies like buprenorphine and methadone can do. Both methadone and buprenorphine are intended to help the individual taper their withdrawal slowly over time, but that means detox can last several more weeks or even months. Some people who work toward sobriety using methadone can be on the maintenance therapy for years.

Clonidine, however, simply suppresses withdrawal symptoms, allowing the individual to detox and enter a rehabilitation program. The medication acts on nerve cells in the brain to lower blood pressure and heart rate, which reduces physical sensations of anxiety or mood swings. By improving attention and suppressive impulsivity, cravings may be reduced too. Depending on several factors, a physician may choose to prescribe clonidine instead of buprenorphine, or they may add clonidine as needed to a prescription for buprenorphine to ease withdrawal symptoms during tapering if they arise.

There are a few withdrawal symptoms that clonidine is not effective against, such as:

  • Muscle aches
  • Insomnia
  • Physical cravings for drugs

More on Detox

Clonidine Doses

Catapres, which is one of the leading clonidine medications, is manufactured by Boehringer Ingelheim. The drug was approved by the FDA to treat high blood pressure for several decades, and in 2010, the safety agency approved the medication to treat ADHD in children. Although clonidine has not been officially approved in rehabilitation settings, it is still widely used in the United States to manage opioid withdrawal symptoms.

Clonidine tablets are available in doses of 0.1 mg, 0.2 mg, and 0.3 mg. The medication also comes with skin patches in the same strengths, which can last one full week. Doses used to treat opioid withdrawal symptoms vary, depending on the individual’s needs, but they typically range from 0.5 mg to 1.4 mg per day. Peak clonidine doses are typically administered between the second and fourth day. The medical professional administering clonidine should make sure to check their patient’s pulse and blood pressure to avoid hypotension or reduced heart rate.

Side Effects

Taking clonidine can lead to side effects like:

  • Exhaustion or tiredness
  • Dry mouth
  • Constipation
  • Vomiting
  • Nausea
  • Decreased sexual desire
  • Nervousness or anxiety
  • Physical weakness
  • Headache

A person could experience dangerous side effects from clonidine, including hypotension (very low blood pressure), cardiac arrhythmia (changes to heart rate), and kidney damage. It is important for the person to take clonidine as prescribed and only for the time period during which they are ending their physical dependence on opioid drugs.

It is rare that a patient abuses clonidine, but people who struggle with prescription drug abuse may attempt to take clonidine to get high. This can lead to overdose symptoms. Clinical guidelines recommend that people in an outpatient program taking clonidine to reduce opioid withdrawal symptoms should not be given more than a three-day supply of the medication to reduce potential overdose dangers.

Side effects from clonidine can be severe, so when it is prescribed, it is recommended that doctors monitor their patients closely.