Drug Name

Dosage & Route

Action

Indication

Adverse Effects

Contraindication

Nursing Responsibility

CLONIDINE HYDROCHLORIDE (kloe'ni-deen) Catapres, CatapresTTS, Dixaril , Duraclon Classifications: cardiovascular agent; central-acting antihypertensive; analgesic

Hypertension Adult: PO 0.1 mg b.i.d. or t.i.d., may increase by 0.10.2 mg/d until desired response is achieved (max: 2.4 mg/d) Transdermal 0.1 mg patch once q7d, may increase by 0.1 mg q12 wk Geriatric: PO Start with 0.1 mg once daily Child: PO 510 mcg/kg/d divided q812h, may increase to 525 mcg/kg/d divided q6h (max: 0.9 mg/d) Severe Pain Adult: Epidural start infusion at 30 mcg/h and titrate to response. Use rates >40 mcg/h with caution Child: Epidural start infusion at 0.5 mcg/kg/h and titrate to response ADDH Child: PO 5 mcg/kg/d in 4 divided doses (average dose, 0.150.2 mg/d) Transdermal 0.20.3 mg/d q57d

Centrally acting antiadrenergic derivative. Stimulates alpha2adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys.

Step 2 drug in steppedcare approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain.

CV: Hypotension (epidural), postural hypotension (mild), peripheral edema, ECG changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt withdrawal. GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction of large bowel, altered taste, nausea, vomiting, hepatitis, hyperbilirubinemia, weight gain (sodium retention). CNS: Drowsiness, sedation, dizziness, headache, fatigue, weakness, sluggishness, dyspnea, vivid dreams, nightmares, insomnia, behavior changes, agitation, hallucination, nervousness, restlessness, anxiety, mental depression. Skin: Rash, pruritus, thinning of hair, exacerbation of psoriasis; with transdermal patch: hyperpigmentation, recurrent herpes simplex, skin irritation, contact dermatitis, mild erythema. Special Senses: Dry eyes. Urogenital: Impotence, loss of libido.

Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE

Assessment & Drug Effects

Monitor BR closely. Determine positional changes (supine, sitting, standing). With epidural administration, frequently monitor BP and HR. Hypotension is a common side effect that may require intervention. Monitor BP closely whenever a drug is added to or withdrawn from therapeutic regimen. Monitor I&O during period of dosage adjustment. Report change in I&O ratio or change in voiding pattern. Determine weight daily. Patients not receiving a concomitant diuretic agent may gain weight, particularly during first 3 or 4 d of therapy, because of marked sodium and water retention. Supervise closely patients with history of mental depression, as they may be subject to further depressive episodes.