Clonidine for Opioid Withdrawal Symptoms
24. If M.T. was opioid dependent, what are the alternatives for management of the symptoms of physical withdrawal while she is treated with epidural opioids?
Clonidine (Catapres) 0.2 to 1.2 mg/day can effectively suppress the signs and symptoms of opioid withdrawal without eliciting other opioid effects.94,95 The specific dose must be individualized for each patient to avoid hypotension, dry mouth, or drowsiness.96,97 Clonidine also can be given sublingually or transdermally in equivalent doses. Clonidine transdermal patches of 3.5, 7.0, and 10.5 cm2 deliver 0.1, 0.2, and 0.3 mg of clonidine, respectively, over a 24-hour period. Approximately 24 hours must elapse before steady-state plasma concentrations of clonidine are attained from the patches.98,99 Therefore, supplemental oral or sublingual96 clonidine 0.1 mg every 6 to 12 hours must be administered during the first 24 hours of the application of the transdermal patches. Clonidine transdermal patches should be used to treat the signs of physical opioid withdrawal only when these symptoms are expected to be severe or prolonged. In addition, clonidine is available for epidural administration and has been used in combination with opioids alone or with opioids and local anesthetics for epidural analgesia. For M.T., who is in labor, clonidine should be avoided owing to the risk of hypotension and possible adverse effects on the fetus. A shorter-acting opioid should be used as in Question 23.
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