Clonidine 100 MCG Arkamin – 600 tablet

CloNIDine may be confused with Clomid, clomiPHENE, clonazePAM, cloZAPine, KlonoPIN, quiNIDine

Catapres may be confused with Cataflam, Combipres

The Institute for Safe Medication Practices (ISMP) includes this medication (epidural administration) among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.

Beers Criteria: Clonidine is identified in the Beers Criteria as a potentially inappropriate medication in patients 65 years and older (independent of diagnosis or condition) for hypertension treatment due to high risk of CNS adverse effects and risk of bradycardia and orthostatic hypotension associated with central alpha blockers. Avoid clonidine as a first-line antihypertensive (Beers Criteria [AGS 2019]).

Use caution when interpreting dosing information. Pediatric dose for epidural infusion expressed as mcg/kg/hour.

Transdermal patch may contain conducting metal (eg, aluminum); remove patch prior to MRI. Errors have occurred when the inactive, optional adhesive cover has been applied instead of the active clonidine-containing patch.

Storage and Stability

Epidural formulation: Store at 20?C to 25?C (68?F to 77?F). Preservative free; discard unused portion.

Tablets: Store at 25?C (77?F); excursions permitted to 15?C to 30?C (59?F to 86?F). Protect from light.

Extended release tablets: Store at 20?C to 25?C (68?F to 77?F). Protect from light.

Transdermal patches: Store at 25?C (77?F); excursions permitted between 15?C to 30?C (59?F and 86?F).

Adverse Reactions

Frequency not always defined.

Oral, Transdermal:?Incidence of adverse events may be less with transdermal compared to oral due to the lower peak/trough ratio.

>10%:

Central nervous system: Drowsiness (2% to 38%), headache (1% to 29%), fatigue (4% to 16%), dizziness (2% to 16%)

Dermatologic: Transient skin rash (localized; characterized by pruritus and erythema; transdermal 15% to 50%), contact dermatitis (transdermal 8% to 34%)

Gastrointestinal: Xerostomia (?40%), upper abdominal pain (15%)

1% to 10%:

Cardiovascular: Bradycardia (?4%), edema (3%), localized blanching (transdermal 1%), palpitations (1%), tachycardia (?3%), atrioventricular block, cardiac arrhythmia, cardiac failure, cerebrovascular accident, chest pain, ECG abnormality, flushing, orthostatic hypotension, prolonged Q-T Interval on ECG, Raynaud’s phenomenon, syncope

Central nervous system: Sedation (3% to 10%), irritability (5% to 9%), nightmares (4% to 9%), insomnia (?6%), emotional disturbance (4%), lethargy (3%), nervousness (1% to 3%), depression (1%), throbbing (transdermal 1%), withdrawal syndrome (1%), aggressive behavior, agitation, anxiety, behavioral changes, delirium, delusions, hallucination (visual and auditory), malaise, numbness (localized; transdermal), paresthesia, parotid pain (oral), restlessness, vivid dream

Dermatologic: Localized vesiculation (transdermal 7%), allergic contact sensitivity (transdermal 5%), hyperpigmentation (transdermal 5%), burning sensation of skin (transdermal 3%), excoriation (transdermal 3%), macular eruption (1%), papule (transdermal 1%), alopecia, hypopigmentation (localized; transdermal), pallor, skin rash, urticaria

Endocrine & metabolic: Gynecomastia (1%), weight gain (<1%), decreased libido, hyperglycemia (transient; oral), increased thirst

Gastrointestinal: Constipation (1% to 10%), viral gastrointestinal infection (5%), anorexia (1%), abdominal pain (oral), diarrhea, gastrointestinal pseudo-obstruction (oral), nausea, parotitis (oral), sore throat, vomiting

Genitourinary: Urinary incontinence (4%), sexual disorder (3%), erectile dysfunction (2% to 3%), nocturia (1%), pollakiuria, urinary retention

Hematologic & oncologic: Thrombocytopenia (oral)

Hepatic: Abnormal hepatic function tests (mild transient abnormalities; <1%), hepatitis

Hypersensitivity: Angioedema

Neuromuscular & skeletal: Weakness (10%), tremor (1% to 4%), arthralgia (1%), myalgia (1%), leg cramps (<1%), increased creatine phosphokinase (transient; oral), limb pain

Ophthalmic: Accommodation disturbance, blurred vision, burning sensation of eyes, decreased lacrimation, dry eye syndrome, increased lacrimation

Otic: Otitis media (?3%), otalgia

Respiratory: Asthma, dry nose, epistaxis, flu-like symptoms, nasal congestion, nasopharyngitis, respiratory tract infection, rhinorrhea

Miscellaneous: Crying (1% to 3%), fever

Epidural:?Note:?The following adverse events occurred more often than placebo in cancer patients with intractable pain being treated with concurrent epidural morphine.

>10%:

Cardiovascular: Hypotension (45%), orthostatic hypotension (32%)

Central nervous system: Confusion (13%), dizziness (13%)

Gastrointestinal: Xerostomia (13%)

1% to 10%:

Cardiovascular: Chest pain (5%)

Central nervous system: Hallucination (5%)

Dermatologic: Diaphoresis (5%)

Gastrointestinal: Nausea and vomiting (8%)

Otic: Tinnitus (5%)