clonidine and similar

[sleepyj]

Although there is some information here about the use of clonidine - or other similar medication - used to aid in some of the withdrawal symptoms, it does seems that more information, experiences, and observations would be useful.

Which symptoms does it mitigate exactly? Does the initial dose necessary of clonidine depend more on the blood pressure of the patient, the severity of the withdrawals, or some other factor? What is the impact of combining it with benzos? Are there different opinions on the taper off of clonidine?

One potential concern of clonidine is that it could make it unsafe to take benzos for anxiety as needed.

Information about similar drugs would be useful - such as lofexidine - although clonidine may be much more available in certain parts of the world.

One clonidine taper to prevent rebound hypotension is stated as " 6 on the first day off, then 8 pills for 8 days, 6 pills, 4 pills, 2 pills." But this is really not clear, does that specifically mean 8 pills a day for 8 days, 6 pills a day for 6 days, 4 pills a day for 4 days, 2 pills a day for 2 days, and then one. A mistake here could be serious. Could blood pressure monitoring be relevant for the taper back down - taking it on an as-needed basis, for example?

Obviously blood pressure monitoring should be combined with clonidine. Combined with an answer to the question about combination with reasonable doses of benzos, does this result in reasonable safety?

How does it impact sleep?

[electrolingus]

Clonidine, used in low doses as a centrally-acting antihypertensive agent, relieves some of the signs and symptoms of opiate withdrawal syndrome when used in high doses. Its mechanism of action is suppression of the sympathetic discharge of the locus ceruleus which is stimulated in opiate (and other) withdrawal states. The autonomic signs and symptoms of withdrawal are suppressed. However, craving, anxiety, bone pain, insomnia, and myalgias usually are not relieved.

Treatment of opiate withdrawal with clonidine requires high dose regimens, relative to the dosages commonly used in the treatment of hypertension, and these can be complicated by potentially serious side effects, especially orthostatic hypotension (which can adversely affect underlying cardiac or vascular disease), fatigue, lethargy, and depression. Further, because symptom coverage is not complete, other medications usually need to be added to clonidine detoxification regimens, often in moderate to high doses.

Other medications used in conjunction with clonidine may include;

Benzodiazepines - added to treat anxiety, insomnia, and muscle cramping. More commonly they are used safely in low to moderate doses as anxiolytic and soporific agents in combination therapy.

NSAIDS - for pain.
Loperamide - for diarrhea.
and so on...
Each of these medications, in turn, has its own side-effect profile with benzodiazepines also having the potential for abuse and diversion.

For recommended clonidine dosing regimens/procedure in the treatment of long-acting and short-acting opioid withdrawal as well as further information on this subject, see here:
http://books.google.com/books?id=URD...esult&resnum=8

Sources:
Psychotropic drug handbook
By Paul J. Perry, Bruce Alexander, Barry I. Liskow, C. Lindsay DeVane

Office-Based Opiate Detoxification - An Open Letter to the FDA
by Alexander DeLuca, M.D.; Addiction, Pain, and Public Health

Reputation Comments on this post:

	Good information and listing of sources
	I used clonidine to detox, SWIelectro seems very wise I want clearer (non-medical term) info! :)
	very useful info

[Spucky]

Originally Posted by sleepyj

Although there is some information here about the use of clonidine - or other similar medication - used to aid in some of the withdrawal symptoms, it does seems that more information, experiences, and observations would be useful.

There is already a lot, please use the Search Engine!

Originally Posted by sleepyj

Which symptoms does it mitigate exactly? Does the initial dose necessary of clonidine depend more on the blood pressure of the patient, the severity of the withdrawals, or some other factor? What is the impact of combining it with benzos? Are there different opinions on the taper off of clonidine?

1. a check up for Blood-Pressure is a must,
everything else is not responsible and can caused Death!

2. Do not mix it with Benzos if swiny is doing it by him self, a monitoring is needed!

3. Do not forget that the Tolerance to Opioids decrease by ca. 40%

Originally Posted by sleepyj

One potential concern of clonidine is that it could make it unsafe to take benzos for anxiety as needed.

Again, don`t mix them.
Anxiety is a part of the Opiate-Withdrawal,
if someone can`t stand it he/she will have big Problems to stay clean!
But Clonidine is helping a lot to rest at least a little bit!
Even closing the Eye`s just for a few Minutes help the Body.

Afair. Clonidine and div. Benzos go to the same Receptor!

Originally Posted by sleepyj

One clonidine taper to prevent rebound hypotension is stated as " 6 on the first day off, then 8 pills for 8 days, 6 pills, 4 pills, 2 pills." But this is really not clear, does that specifically mean 8 pills a day for 8 days, 6 pills a day for 6 days, 4 pills a day for 4 days, 2 pills a day for 2 days, and then one. A mistake here could be serious. Could blood pressure monitoring be relevant for the taper back down - taking it on an as-needed basis, for example?

If Swiny don`t have a proper Plan without Misunderstandings do not follow them!
My Cat recommend to let it be decide by a real Medic!

Originally Posted by sleepyj

Obviously blood pressure monitoring should be combined with clonidine. Combined with an answer to the question about combination with reasonable doses of benzos, does this result in reasonable safety?

No, because if someone use a Benzo. with a long Half-life Periode
it becomes dangerous!

Originally Posted by sleepyj

How does it impact sleep?

It help a lot to Rest!

My Cat is nearly sure that there are some Files in the File-Section
where every question will be answered!

Regards

This post doesn't have a point. What little information it provides is incomplete and difficult to understand.

Instead of giving just a bad Reputation you have to add. Information, i just answer all the questions,
if there is a "different" question i will answer them too!
I dislike People like you!

Reputation Comments on this post:

	if youre not happy with rep points, report them, dont disrupt the thread.
	Important info that outlines the dangers of mixing benzos with other medications.

[sleepyj]

The Psychotropic Drug Handbook and The American Psychiatric Textbook Of Substance Abuse Treatment seem to have more information on Clonidine than can be found by the search engine here. Pointers to any thread that discusses Clonidine that contains information beyond that would be interesting, it's certainly not easily found with the search engine.

Both books discuss the use of benzos along with clonidine, on an outpatient basis, without significant warning of dangers.

It is interesting that the use of the search engine would be advised, and yet following a plan without misunderstandings is advised against, when the most thorough advice for the use of Clonidine to aid detox that the search engine on this site finds contains the very unclear information that I quoted.

The above mentioned books seem much more complete in the one or two relevant pages than everything that's been posted to these forums.

Interestingly, both books discuss the use of clonidine to mitigate symtoms during a precipitated withdrawal caused by naltrexone. They describe this being done on an outpatient basis, and describe it as safe and effective.

So far these books seem to be the most informative and thorough source for information on clonidine-assisted detox.

[Spucky]

http://www.pubmedcentral.nih.gov/art...?artid=2561435
http://www.freepatentsonline.com/4312878.html
http://www.drugs-forum.com/forum/showthread.php?t=46291
http://www.uptodate.com/patients/content/topic.do?topicKey=~61WlKtoSDhDSo1

etc.

But do not forget that mostly all Study`s are not up to Date!

[Boh Girl]

SWIM agrees there is info on clonidine here, but more could be used because it can be dangerous.. I think he meant to expand the subject. I've been searching it too and tempted to start my own but SWIM'll try here instead and hope it's read.

SWIelectrolingus has it right ISO
SWIM had a 100mg+ addiction to oxycontin. She tried to stop cold turkey, 6 days in rushed to emergency room SWIM was really in bad shape & doesn't remember much. Thank SWIMS friends! the doctor said SWIM needed to at least ween and told her to get a doctor. After weeks of trying to find a family doc, she settled on the best she could find. He prescribed her codeine to ween onto, clonidine without checking SWIMS blood pressure and Librium, saying to take no more than 2 each per 6 hrs.
After successfully getting off oxy and onto codeine SWIM lowered her codeine amount and wrote the day to stop on the calendar. She did it, taking clonidine and librium as prescribed.

THIS IS IMPORTANT
SWIM already had slightly low systolic, diastolic etc readings from those machines they have at pharmacies where you can get it done but didn't think of it. Because of this, when SWIM would take clonidine her heart rate dropped severely. SWIMS friend came and took her pulse, SWIM isn't medically trained in any way her friend knew a bit about this. SWIMs pulse was VERY low, a few points above comatose, and that is how SWIM felt. She couldn't move, sleep, talk, she felt totally in a cocoon disconnected from reality, but in a bad way. A Coma way. the important part is to make sure your pulse is high or well. (systolic/diastolic/both? I don't know please excuse my ignorance towards this)

SWIM immediately stopped clonidine which sucked because it did help, but the librium seems to be ok.. and she would take one after going a full 24 hours or so and after learning to count her pulse and judging herself. SWIM doesn't recommend this, SWIM was self doctoring and should have gone back to her doc and told him but he kept pushing methadone and swim knew she could do without.

Basically SWIM'd recommend clonidine for stopping, she had chills and muscle problems that would disappear after her clonidine/librium cocktail twice a day as prescribed, (she had tried everything she had heard of including DXM) but the near-coma thing - NOT GOOD - check that heart rate first

Reputation Comments on this post:

Thanks for the account and for addressing the importance of using clonidine safely. Welcome to the Forum.

[dyingtomorrow]

SWIM's used clonodine for heroin withdrawals probably close to a hundred times. He "inherited" a couple huge bottles from his dead uncle, which were a major boon during the conversion phase from heroin addict with money to heroin addict with no money withdrawing all the fucking time. The main things it relieves in his experience are the hot and cold flashes, the crazy kicking legs, and maybe some joint pain. It also seems to calm you down a little, SWIM finds he can sit in one position longer on clonodine, rather than spinning around into 20 different positions every 1 minute.

It's "said," at least in SWIM's world, that clonodine takes about half the horror of withdrawal away. Which still leaves a lot.

[EyesOfTheWorld]

Hmm. SWIM's ex had many, many bottles of clonodine laying about, and when he decided to attempt a home heroin detox, she presented them to him as a gift, along with a heaping pile of xanax and a guilt trip longer than 5 DOx eperiences. Anyway, he asked around, and many former and current addicts, as well as people he knows in the Recovery Industry (and yes, it's a for profit industry like anything else), and he was told it worked wonders for withdrawal. He was happy and confident, quit H abrubtly and got on clonodine and xanax, as well as 8mgs suboxone every morning. The sub and xanax helped but he experienced no real benefit from clonodine at any dose. Predictably he's back on opiates.
However just because it failed for SWIM doesn't mean it will for others. The fact that so many other people in the know said it did work indicates that it does for at least most people.

[Dickon]

sleepyj, I think I recognise my clonidine taper there. I mean 6 pills a day for one day, 8 pills a day for 8 days, 6 pills for one day, 4 pills for one day, 2 pills for one day, and then come off. Even if that's not my taper, that's certainly what is meant. I shall have a look at the "how to guide" post I wrote and edit to make that a bit more clear. Again, if this is what I wrote it is a guideline and I have posted the warning about hypotension and how blood pressure should be monitored and dose reductions made if appropriate. Normally people undergoing w.d.s are prone to an increase in blood pressure, so this to some extent offsets the lowering of blood pressure by the clonidine. It is usually used for a fairly short time during an opiate detox so the need to taper off is more as a precaution.

As far as effects go, I'd say dyingtomorrow pretty much hits the nail on the head. It really doesn't eliminate any w.d. symptom completely, and in addition to what dyingtomorrow says I think it helps with runny nose and eyes too. It works on the adrenergic receptors and not the GABA receptors where benzodiazepines work, as someone mentioned above. I'd imagine benzos would lower blood pressure and so caution should be used when combining benzos and clonidine, but it seems to be a fairly frequently used combination.

In the UK clonidine is not approved for outpatient detox, but lofexidine is. Lofexidine is similar to clonidine in that it is an alpha-2 adrenergic agonist, but it does not have such strong effects on blood-pressure. It is thus a slightly safer drug.

If clonidine or lofexidine increase sleep in opiate detox this effect is pretty small.

My cat once came off 200mg/day methadone in 2 days with clonidine and no other medication (other than the benzos used in the taper), whilst coming off benzos (10 day taper) and alcohol (cold turkey). There is no way on God's earth cat could have done this without the clonidine. That said it was a rough experience but made possible by the clonidine. Cat never found clonidine or lofexidine to be anything close to the theoretical ideal, but they bring w.d.s down from impossible horrors to just-bearable agony.

Reputation Comments on this post:

	great medical knowledge and advice as always!
	Sums things up nicely. Informative, easily understood, and very helpful.

[EyesOfTheWorld]

Ah, yes, forgot that clonidine does definitely help with sleep and a bit of high blood pressure, if SWIY has these problems. SWIM didnt but only due to having plenty of benzos. For SWIYs trying to kick all psychoactives, including benzos, it probably does assist, but in SWIMs opinion its not the miracle cure rehab pros make it out to be (and note: SWIM, in addition to being a drug addict, is also a certified addiction counselor by profession-yes, the irony is a bit much, but it goes to show he knows what he speaks of)

[$limJim]

Slim thought that Clonidine was sometimes used to cut heroin, or is he thinking of something else?

[EyesOfTheWorld]

Originally Posted by $limJim

Slim thought that Clonidine was sometimes used to cut heroin, or is he thinking of something else?

Pretty sure SWIY means quinine, the shit Nicky Barnes (American Gangster) popularized in the Vietnam era.