Clonidine is commonly prescribed for alcohol withdrawal, along with sever other medications. It is prescribed to treat some of the physical side effects of alcohol withdrawal syndrome (AWS).
During alcohol withdrawal, the sympathetic nervous system goes into overdrive as the body attempts to stabilize. Clonidine helps control symptoms of this overactive state, such as high blood pressure and rapid heartbeat.
Clonidine is prescribed in conjunction with other medications and support rather than as a stand-alone treatment. This overview explains when and how clonidine is used for alcohol withdrawal, possible benefits and side effects, and how it fits into overall alcohol recovery treatment.
Key Facts
- Clonidine is an antihypertensive medication used to manage autonomic symptoms of alcohol withdrawal (high blood pressure, anxiety, tremors).
- Clonidine is an adjunct medication for alcohol withdrawal, prescribed in combination with other treatments.
- Clonidine dosing requires close monitoring during treatment and careful tapering post-withdrawal.
- Precautions must be taken for patients with certain conditions or who are taking other medications.
- Treatment including clonidine and follow-up care is available in inpatient and outpatient settings.
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Clonidine for Alcohol Withdrawal
Clonidine is an alpha-2 adrenergic agonist. This means it reduces nerve signals to the brain, to calm the “fight-or-flight” response in the body.
During alcohol withdrawal, the body goes into this “fight-or-flight” mode as it adjusts to the absence of alcohol. The calming effect of clonidine is helpful to reduce the side effects of hypertension, tremor, anxiety, and tachycardia.
Clonidine’s Role in Treatment
While it can be effective in treating certain autonomic symptoms, clonidine is not a stand-alone treatment for alcohol withdrawal. It is often used adjunctively to benzodiazepines.
Benzodiazepines are considered first-line alcohol withdrawal medications. They provide the main defense against withdrawal, while clonidine comes alongside to address specific hypertensive symptoms.
What Clonidine Does Not Do
Clonidine can help calm the body, but it does not prevent seizures or delirium tremens (DTs).
These are a severe form of alcohol withdrawal with life-threatening symptoms. Due to this limitation, detox protocols rely on other alcohol withdrawal medications to address these risks. Benzodiazepines and phenobarbital are typically prescribed to reduce the risk of seizures and DTs.
It’s also important to note that clonidine is not an anti-craving medication for alcohol withdrawal. The aim of clonidine treatment is to address certain physical side effects of withdrawal. Relapse prevention medications that address cravings may be prescribed separately post-withdrawal.
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How Clonidine Fits into Alcohol Withdrawal Care
Clonidine can be an important part of alcohol withdrawal care, as one of several alcohol withdrawal medications prescribed during alcohol detox. Here’s how it fits into an overall care plan.
Withdrawal Basics
Symptoms of alcohol withdrawal typically start around six hours after the last drink. They peak within 24 to 72 hours and usually last up to one week.
Severe cases of alcohol withdrawal can progress to seizures or DTs. Because of this risk, it is important to choose an appropriate setting for alcohol detox. Often, inpatient treatment is necessary to safely manage symptoms.
Assessing the Severity of Symptoms
Clinicians use a structured scale called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) to assess the severity of withdrawal symptoms. The assessment includes 10 categories of symptoms.
The total score on this scale guides clinicians in prescribing medications such as clonidine. Repeated assessments allow clinicians to monitor the patient’s progression through the withdrawal process and adjust treatment as needed.
Targeted Treatment
As an alpha-2 adrenergic agonist, clonidine reduces the release of norepinephrine. The effect is a reduction in the hyperarousal state caused by alcohol withdrawal. This, in turn, reduces heart rate, blood pressure, tremors, sweating, and anxiety.
Because the medication is targeted to address these effects of alcohol withdrawal, it is best used in conjunction with other alcohol withdrawal medications. As clonidine treats autonomic hyperactivity, other treatments manage or prevent symptoms such as seizures or cravings.
When & How Clinicians Use Clonidine
Not every person who goes through alcohol withdrawal receives clonidine as part of their treatment.
Clinicians may prescribe clonidine in specific circumstances:
- CIWA-Ar results indicate medication is appropriate
- Autonomic signs persist despite benzodiazepine dosing
- The patient is hypertensive/tachycardic
Care Settings for Clonidine Treatment
Clonidine treatment is appropriate for inpatient settings, where patients receive 24/7 care.
Clinicians may also prescribe clonidine in outpatient settings, which include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and doctors offices, where patients are closely monitored.
This supervised care allows clinicians to check the patient’s blood pressure and heart rate regularly. Clonidine dosing with other alcohol withdrawal medications can be adjusted as needed for optimal results.
Dosing & Tapering
Clonidine is most often prescribed as an oral tablet that is taken every six to eight hours. In certain cases, a transdermal patch may be used.
The patch delivers constant medication to the body for several days. Clinicians determine which method is best based on each patient’s symptoms and medical history.
Once clonidine treatment is no longer necessary, some patients must taper off the medication to avoid rebound hypertension. Clinicians will provide a specific tapering plan in their discharge instructions.
Clonidine Benefits, Risks, Interactions
As with all alcohol withdrawal medications, clonidine offers benefits, but it also has limitations and potential side effects.
Benefits vs. Limitations
| Clonidine Benefits | Clonidine Limitations |
| -Reduces uncomfortable autonomic symptoms -High blood pressure -High heart rate -Anxiety -Tremors | -No anticonvulsant effect -Cannot replace benzodiazepines for seizure/DT prevention |
| May lower total benzodiazepine exposure | Must be tapered in some patients |
Side Effects, Precautions & Interactions
Common side effects of clonidine use include:
In some cases, clonidine can cause hypotension (low blood pressure) or bradycardia (slow heart rate).
This is related to dosing and can be monitored and corrected by the prescribing clinician. Parameters are put in place to determine the appropriate dose and prevent these conditions.
Extra caution must also be taken with patients who meet certain criteria:
- Older age: Seniors may be at higher risk for complications/side effects.
- Renal impairment: Dosing adjustments may be necessary based on kidney function.
- Conduction disease: This affects the electrical system that controls the heart.
- Other blood pressure medications and beta-blockers: When prescribed in conjunction with clonidine, these may cause blood pressure or heart rate to drop too low.
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How Clonidine Compares to Other Alcohol Withdrawal Medications
Clonidine is used in conjunction with other addiction withdrawal medications. Following are a few of the most common.
Clonidine vs. Benzodiazepines
Benzodiazepines remain the first-line treatment for alcohol withdrawal. These medications provide protection from seizures and delirium tremens and can provide light sedation.
In contrast, clonidine treats autonomic symptoms only. Some older research explored clonidine use in comparison to chlordiazepoxide (a benzodiazepine).
However, results have shown benzos to be the preferred method for core alcohol withdrawal syndrome (AWS) control.
Other Adjunct Alcohol Withdrawal Medications You May Hear About
In addition to clonidine, other adjunct medications may be prescribed in combination with benzodiazepines to treat AWS.
- Dexmedetomidine: Like clonidine, this is an alpha-2 adrenergic agonist that calms the central nervous system. It is typically used in extreme cases, when a patient is being treated in the ICU for severe autonomic hyperactivity and is under monitored care. It does not prevent seizures.
- Gabapentin: This anticonvulsant is used off-label to treat symptoms of AWS such as cravings, anxiety, and insomnia.
- Carbamazepine: This anticonvulsant may also be used for AWS, particularly in mild or moderate cases or in combination with other medications.
- Beta-blockers: These medications are sometimes used to control blood pressure or heart rate.
Clonidine FAQs
No. Clonidine eases sympathetic symptoms but does not prevent seizures or delirium tremens. It is used only as an adjunct medication within a supervised medical protocol.
This depends on the severity of symptoms and the support available.
Clonidine should only be used under a doctor’s guidance and with reliable follow-up. A plan must be in place to escalate to higher care if vitals or symptoms worsen.
Sometimes. Abrupt discontinuation can trigger rebound hypertension. Supervising clinicians should provide a clear taper plan (step-down dosing over several days) if you need one.
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