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Antihypertensive Clonidine Withdrawal: Psych Meds not the only drugs to cause PAWS

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csm2014

The abrupt withdrawal or too rapid tapering of many, but not all, antihypertensive drugs can typically result in symptoms of overactivity and acute upregulation of the beta adrenoreceptors in the sympathetic nervous system similar to those of potent psychotropic meds, causing rebound hypertension worse than the hypertension it's treating, panic attacks, anxiety, depression, and suicidal ideation. It is important to note that some of us have found out the hard way that we are more susceptible to sympathetic nervous over-stimulation following abrupt withdrawal or rapid tapering of treatment of antihypertensive meds than others and, similar to the ignorance in tapering psych meds, most doctors are largely unaware and inexperienced in gauging clear symptoms of protracted acute withdrawal syndrome (PAWS) of blood pressure meds, writing the patient off as a hypochondriac or one with an anxiety disorder.

 

It took 18 mos. for me to finally come to the clear realization of what got me into this mess, why it was so difficult to discern, and why I finally and unfortunately had to resort to psych meds as my last straw to gain functionality and stability. It also wasn't until I came to a site like this that educated me as to how so important correct (slow) tapering is - and that it needs to apply to not just psych meds, but to ANY med that can affect any part of the nervous system. Little did I know how hypersensitive my sympathetic nervous system was going to be from the acute upregulation of beta adrenoreceptors.

 

I would therefore like to add to the list of post-acute withdrawal syndromes a very potent antihypertensive drug that isn't, but should be, considered a very powerful psych med that has every bit of potential withdrawal punch as the worst of the worst psych meds if not tapered SLOWLY: CLONIDINE. Yes, Clonidine, the emergency blood pressure med that is sometimes recommended as a means to temper benzo, ADs, and opiate withdrawal, which is ironic because the very drug I am still on and need to taper off like yesterday is the benzo, Klonopin! How's that for a curse that comes back full circle? Also ironic is the similarity in names as a side note. But no way would I ever even consider using Clonidine for any reason, let alone any drug, for withdrawing off another. Usually it's from Klonopin to Clonidine, but in my case, it was from Clonidine to Klonopin.

This is one of the better links from this forum I could find that explains the dangers of Clonidine:

http://survivingantidepressants.org/index.php?/topic/6216-non-psych-drugs-causing-psych-symptoms/?hl=clonidine

 

The short story which I covered less clearly in my signature line is that my nervous system setback was definitely iatrogenic. First off, the use of Clonidine as a first line agent in the management of my moderate hypertension was total MIS-management on the part of my physician at the time. Secondly, I was put on a sustained-release patch. Well, hello, a patch you CANNOT TAPER (but this wasn't something I had any concept of at the time). And guess what next? Clonidine's most prolific side effect is acute rebound hypertension if you stop cold turkey. After two weeks on the patch, I couldn't take the side effects (lethargy, dry mouth, bradycardia, exercise intolerance, orthostatic hypotension, etc.) and read on a pubmed study that the patch doesn't exhibit the rebound effect that the tablets do. Boy, was that bad advice. I pulled the patch off, and within 48h in the middle of sleeping, had my first acute rebound hypertensive panic attack and tremors, landing me in the ER, my BP soaring to 190/100, pulse 120. I had never experienced a scare like this before where I literally thought I would stroke out or have a heart attack. I fortunately had some tablets on hand which stabilized me for the time being. At the instructions of my doc, I then tapered to the next lower dose, but it was still a patch!

 

As a result from not being to taper using a patch (you cannot cut it, as it deactivates the active drug in the patch), I continued to suffer from intermittent rebound withdrawal even with the lower-dose patch and weeks later when I was switched to Bystolic and then Carvedilol to buffer the w/d, both beta blockers.

 

The sad part is that I had Clonidine tablets I could've used for a 10% taper, but I had no knowledge of tapering back then, getting advice from doctors that gave me the wrong advice when it came to tapering (too rapid).

 

I suffered a total of twenty intermittent unprovoked rebound/panic attacks in the six months following my discontinuation of Clonidine, was in the ER a few more times, where again each episode was an exact repeat in which my BP shot up and I thought I was going to die.

 

Every doc I've told that story to cannot believe that I was ever put on Clonidine as a first line drug for moderate hypertension. It should ONLY used as a last resort in emergency situations and for resistant hypertension and adrenergic storms (acute panic attacks) which ironically and paradoxically, is exactly what it caused in my case.

Fortunately, I no longer suffer from those hypertensive rebounds/panic attacks (the last one was in Sept. of last year), but unfortunately had to resort to the Lamictal/Klonopin as the only safe haven at the time.

 

If I had even half the knowledge I have now on tapering, I feel confident I would've been out of this hole well before the end of last year and without ever touching a psych med. Thanks to the ignorance of my initial docs, they didn't take into consideration the effects that BP med withdrawal can have and that it can be every bit as serious as psych med withdrawal.

 

I caution that anyone taking Clonidine and their precribers need to be forewarned that this med can definitely cause PAWS if not tapered very slowly and the patch should be banned altogether since neither it's half-life nor taper can be successfully controlled.

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compsports

CSM2014,

 

I am so sorry for what you experienced.

 

I would also add beta blockers to that list.   I had a horrible adverse reaction to Coreg and fortunately, got off of it after 2 days.   But there is no doubt in my mind, that if I had been on it longer, I would have had horrible WD symptoms because they occurred even after 2 days.

 

A big fat sigh!

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csm2014

CSM2014,

 

I am so sorry for what you experienced.

 

I would also add beta blockers to that list.   I had a horrible adverse reaction to Coreg and fortunately, got off of it after 2 days.   But there is no doubt in my mind, that if I had been on it longer, I would have had horrible WD symptoms because they occurred even after 2 days.

 

A big fat sigh!

I had seen your previous posts regarding your reactions to Coreg and was very surprised, as Coreg is the safest amongst all BBs since it does not upregulate beta adrenoreceptors that the others do. I have been on it a year and have had no problems (that I can tell) with it thus far. It almost sounds like yours was an acute hypersensitivity reaction to it from being on it for such a short time - or perhaps was an acute interaction between it and other meds at the time that didn't mix well. This shows us that we are all so biochemically unique in how we respond to different meds. I am sure there are some that react violently to aspirin. At least your experience was over with quickly whereas I suffered for months and am still not out of the woods. I also have sleep apnea (or UARS) and that alone left untreated can cause many nervous system symptoms as well as hypertension. I have not been able to tolerate CPAP, so am looking into oral appliances again.

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compsports

 

CSM2014,

 

I am so sorry for what you experienced.

 

I would also add beta blockers to that list.   I had a horrible adverse reaction to Coreg and fortunately, got off of it after 2 days.   But there is no doubt in my mind, that if I had been on it longer, I would have had horrible WD symptoms because they occurred even after 2 days.

 

A big fat sigh!

I had seen your previous posts regarding your reactions to Coreg and was very surprised, as Coreg is the safest amongst all BBs since it does not upregulate beta adrenoreceptors that the others do. I have been on it a year and have had no problems (that I can tell) with it thus far. It almost sounds like yours was an acute hypersensitivity reaction to it from being on it for such a short time - or perhaps was an acute interaction between it and other meds at the time that didn't mix well. This shows us that we are all so biochemically unique in how we respond to different meds. I am sure there are some that react violently to aspirin. At least your experience was over with quickly whereas I suffered for months and am still not out of the woods. I also have sleep apnea (or UARS) and that alone left untreated can cause many nervous system symptoms as well as hypertension. I have not been able to tolerate CPAP, so am looking into oral appliances again.

 

Hmm, even if you are medical professional, I am not sure how you can make a blanket statement that a med is one of the safest in its classes.   Beta blockers are very well known to cause depression even if it is not a common reaction.

 

No, I wasn't on any other meds.

 

I am sorry you have suffered so much.

 

I am reevaluating whether to stay on pap therapy.  I hope an oral appliance works for you.

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csm2014

 

 

CSM2014,

 

I am so sorry for what you experienced.

 

I would also add beta blockers to that list.   I had a horrible adverse reaction to Coreg and fortunately, got off of it after 2 days.   But there is no doubt in my mind, that if I had been on it longer, I would have had horrible WD symptoms because they occurred even after 2 days.

 

A big fat sigh!

I had seen your previous posts regarding your reactions to Coreg and was very surprised, as Coreg is the safest amongst all BBs since it does not upregulate beta adrenoreceptors that the others do. I have been on it a year and have had no problems (that I can tell) with it thus far. It almost sounds like yours was an acute hypersensitivity reaction to it from being on it for such a short time - or perhaps was an acute interaction between it and other meds at the time that didn't mix well. This shows us that we are all so biochemically unique in how we respond to different meds. I am sure there are some that react violently to aspirin. At least your experience was over with quickly whereas I suffered for months and am still not out of the woods. I also have sleep apnea (or UARS) and that alone left untreated can cause many nervous system symptoms as well as hypertension. I have not been able to tolerate CPAP, so am looking into oral appliances again.

 

Hmm, even if you are medical professional, I am not sure how you can make a blanket statement that a med is one of the safest in its classes.   Beta blockers are very well known to cause depression even if it is not a common reaction.

 

No, I wasn't on any other meds.

 

I am sorry you have suffered so much.

 

I am reevaluating whether to stay on pap therapy.  I hope an oral appliance works for you

Not a medical professional, just have done scads of research on BBs and Carvedilol (Coreg brand name) in particular. It is a third-generation BB and its safety profile is much better than that of the older class which are much more lipophilic (cross of the blood-brain barrier) and are known to cause CNS depression (i.e. propanolol, metropolol). http://www.ncbi.nlm.nih.gov/pubmed/2865153

Coreg is weakly lipophilic so any CNS effects I would think would be dose dependent.

 

You and I are exceptions to the majority, mine being with Clonidine, and yours with Coreg. Bottom line is that neither could get paid enough money to ever go on these drugs no matter what!

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spectio

This may not be the best place to ask this question or maybe it has been answered some where else. Does anyone in our SA community find problems with tolerating other pharmaceuticals in general?

 

I have been on every antihypertensive drug class there is and I have not been able to tolerate any of them. The last one was clonidine and I dumped that bad boy after ten days.

 

After trying alpha blockers, beta blockers, calcium channel blockers, diuretics, I have always gone back to ace inhibitors. I've taken lisinopril now for six years and before that another ten years of another ace inhibitor. Unfortunately, what I thought were prolonged AD withdrawal symptoms were side effects of the lisinopril. I now have constant ringing in my ears with worrisome hearing changes, leg cramps, constant dizzyness, nighttime reflux, sleeping issues, night sweats, eye issues with vision changes, etc. etc.

 

I don't know what to do. I take 10 mg at night which is the lowest dose that is prescribed for hypertension but still these side effects persist. I've recently tried to take 9 mg and I can feel my blood pressure creep up. So back to ten mg.

 

I walk, eat regular meals of home cooked foods, eat little grains, no alcohol, no smoking, no other drugs or supplements.

 

Alto, you were right back in 2011 when you told me you suspected I was having problems with lisinopril. But what are we to do who have hypertension. I don't want to be deaf but I sure don't want to have a stoke either. I saw my mother go through two of those and the last one killed her.

 

Anyway, I guess my question to the community is anyone else having issues with other drugs, particularly antihypertensives and what have you done to cope?

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compsports

This may not be the best place to ask this question or maybe it has been answered some where else. Does anyone in our SA community find problems with tolerating other pharmaceuticals in general?

 

I have been on every antihypertensive drug class there is and I have not been able to tolerate any of them. The last one was clonidine and I dumped that bad boy after ten days.

 

After trying alpha blockers, beta blockers, calcium channel blockers, diuretics, I have always gone back to ace inhibitors. I've taken lisinopril now for six years and before that another ten years of another ace inhibitor. Unfortunately, what I thought were prolonged AD withdrawal symptoms were side effects of the lisinopril. I now have constant ringing in my ears with worrisome hearing changes, leg cramps, constant dizzyness, nighttime reflux, sleeping issues, night sweats, eye issues with vision changes, etc. etc.

 

I don't know what to do. I take 10 mg at night which is the lowest dose that is prescribed for hypertension but still these side effects persist. I've recently tried to take 9 mg and I can feel my blood pressure creep up. So back to ten mg.

 

I walk, eat regular meals of home cooked foods, eat little grains, no alcohol, no smoking, no other drugs or supplements.

 

Alto, you were right back in 2011 when you told me you suspected I was having problems with lisinopril. But what are we to do who have hypertension. I don't want to be deaf but I sure don't want to have a stoke either. I saw my mother go through two of those and the last one killed her.

 

Anyway, I guess my question to the community is anyone else having issues with other drugs, particularly antihypertensives and what have you done to cope?

I definitely have trouble with taking other meds as an adverse reaction to cardizem  put me in the ER..

 

After my septoplasty in March, my BP went down to normal without meds.   What seemed to help in particular was reducing my salt intake as much as possible and walking up the stairs at least twice a day.

 

It sounds like you are doing everything possible non med wise.  The only suggestion I would make is to make sure your diet contains enough potassium, magnesium, and calcium as I have read those are keys to keeping BP low. 

 

And look into your salt intake.   I know someone who was able to substantially reduce his blood pressure meds by going on the Pritikin diet which is very low salt.

 

What is your BP if you don't take meds?  Is it really high enough to put your at risk for a stroke if you don't treat it?

 

Regarding lisiniprol, have you done a google search to make sure it isn't depleting any nutrients as several drugs do which can cause some adverse reaction.

 

Best of luck as it sounds like you are really in a bind.

 

CS

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csm2014

 

This may not be the best place to ask this question or maybe it has been answered some where else. Does anyone in our SA community find problems with tolerating other pharmaceuticals in general?

 

I have been on every antihypertensive drug class there is and I have not been able to tolerate any of them. The last one was clonidine and I dumped that bad boy after ten days.

 

After trying alpha blockers, beta blockers, calcium channel blockers, diuretics, I have always gone back to ace inhibitors. I've taken lisinopril now for six years and before that another ten years of another ace inhibitor. Unfortunately, what I thought were prolonged AD withdrawal symptoms were side effects of the lisinopril. I now have constant ringing in my ears with worrisome hearing changes, leg cramps, constant dizzyness, nighttime reflux, sleeping issues, night sweats, eye issues with vision changes, etc. etc.

 

I don't know what to do. I take 10 mg at night which is the lowest dose that is prescribed for hypertension but still these side effects persist. I've recently tried to take 9 mg and I can feel my blood pressure creep up. So back to ten mg.

 

I walk, eat regular meals of home cooked foods, eat little grains, no alcohol, no smoking, no other drugs or supplements.

 

Alto, you were right back in 2011 when you told me you suspected I was having problems with lisinopril. But what are we to do who have hypertension. I don't want to be deaf but I sure don't want to have a stoke either. I saw my mother go through two of those and the last one killed her.

 

Anyway, I guess my question to the community is anyone else having issues with other drugs, particularly antihypertensives and what have you done to cope?

I definitely have trouble with taking other meds as an adverse reaction to cardizem  put me in the ER..

 

After my septoplasty in March, my BP went down to normal without meds.   What seemed to help in particular was reducing my salt intake as much as possible and walking up the stairs at least twice a day.

 

It sounds like you are doing everything possible non med wise.  The only suggestion I would make is to make sure your diet contains enough potassium, magnesium, and calcium as I have read those are keys to keeping BP low. 

 

And look into your salt intake.   I know someone who was able to substantially reduce his blood pressure meds by going on the Pritikin diet which is very low salt.

 

What is your BP if you don't take meds?  Is it really high enough to put your at risk for a stroke if you don't treat it?

 

Regarding lisiniprol, have you done a google search to make sure it isn't depleting any nutrients as several drugs do which can cause some adverse reaction.

 

Best of luck as it sounds like you are really in a bind.

 

CS

 

Wow, seems like hypertensives cause paradoxic-like reactions in you. Great news to hear your BP decreased after having your septoplasty - and that you were able to get off BP meds! I am also going to have a septo as a have a deviated septum which contributes to my apnea. I was just afraid to move forward at this time while tapering psych meds (as I will be prescribed opiate pain killer and antibiotics to take for a short while which I am afraid would interact), but my doc doesn't think it will be a problem and instead feels it is necessary to get my sleep issues resolved which would only help the w/d symptoms. Would love to get some inpuit from others on this.

 

Oxygen deprivation during sleep is a bigger issue than I had ever thought, is often misdiagnosed or missed completely and can contribute to many of our symptoms; it affects EVERYTHING (BP, nervous system, hormones, blood coagulation, heart rate, etc.).

 

The consensus amongst the alternative community is that it's refined/processed (table) salt that is the culprit in worsening hypertension, and that Celtic Sea Salt or better yet, Himalayan Pink Salt, in moderation, actually lowers BP in moderation as it contains a balance of other key BP-lowering minerals (i.e. potassium, magnesium) in a natural bound matrix. I use both myself, albeit sparingly. There is also one called Wright Salt http://www.tahomaclinicblog.com/introducing-wright-salt/developed by Dr. Wright.

We need sodium, just in the right balance with other minerals. A lack of sodium stresses the adrenals also.

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compsports

 

 

This may not be the best place to ask this question or maybe it has been answered some where else. Does anyone in our SA community find problems with tolerating other pharmaceuticals in general?

 

I have been on every antihypertensive drug class there is and I have not been able to tolerate any of them. The last one was clonidine and I dumped that bad boy after ten days.

 

After trying alpha blockers, beta blockers, calcium channel blockers, diuretics, I have always gone back to ace inhibitors. I've taken lisinopril now for six years and before that another ten years of another ace inhibitor. Unfortunately, what I thought were prolonged AD withdrawal symptoms were side effects of the lisinopril. I now have constant ringing in my ears with worrisome hearing changes, leg cramps, constant dizzyness, nighttime reflux, sleeping issues, night sweats, eye issues with vision changes, etc. etc.

 

I don't know what to do. I take 10 mg at night which is the lowest dose that is prescribed for hypertension but still these side effects persist. I've recently tried to take 9 mg and I can feel my blood pressure creep up. So back to ten mg.

 

I walk, eat regular meals of home cooked foods, eat little grains, no alcohol, no smoking, no other drugs or supplements.

 

Alto, you were right back in 2011 when you told me you suspected I was having problems with lisinopril. But what are we to do who have hypertension. I don't want to be deaf but I sure don't want to have a stoke either. I saw my mother go through two of those and the last one killed her.

 

Anyway, I guess my question to the community is anyone else having issues with other drugs, particularly antihypertensives and what have you done to cope?

I definitely have trouble with taking other meds as an adverse reaction to cardizem  put me in the ER..

 

After my septoplasty in March, my BP went down to normal without meds.   What seemed to help in particular was reducing my salt intake as much as possible and walking up the stairs at least twice a day.

 

It sounds like you are doing everything possible non med wise.  The only suggestion I would make is to make sure your diet contains enough potassium, magnesium, and calcium as I have read those are keys to keeping BP low. 

 

And look into your salt intake.   I know someone who was able to substantially reduce his blood pressure meds by going on the Pritikin diet which is very low salt.

 

What is your BP if you don't take meds?  Is it really high enough to put your at risk for a stroke if you don't treat it?

 

Regarding lisiniprol, have you done a google search to make sure it isn't depleting any nutrients as several drugs do which can cause some adverse reaction.

 

Best of luck as it sounds like you are really in a bind.

 

CS

 

Wow, seems like hypertensives cause paradoxic-like reactions in you. Great news to hear your BP decreased after having your septoplasty - and that you were able to get off BP meds! I am also going to have a septo as a have a deviated septum which contributes to my apnea. I was just afraid to move forward at this time while tapering psych meds (as I will be prescribed opiate pain killer and antibiotics to take for a short while which I am afraid would interact), but my doc doesn't think it will be a problem and instead feels it is necessary to get my sleep issues resolved which would only help the w/d symptoms. Would love to get some inpuit from others on this.

 

Oxygen deprivation during sleep is a bigger issue than I had ever thought, is often misdiagnosed or missed completely and can contribute to many of our symptoms; it affects EVERYTHING (BP, nervous system, hormones, blood coagulation, heart rate, etc.).

 

The consensus amongst the alternative community is that it's refined/processed (table) salt that is the culprit in worsening hypertension, and that Celtic Sea Salt or better yet, Himalayan Pink Salt, in moderation, actually lowers BP in moderation as it contains a balance of other key BP-lowering minerals (i.e. potassium, magnesium) in a natural bound matrix. I use both myself, albeit sparingly. There is also one called Wright Salt http://www.tahomaclinicblog.com/introducing-wright-salt/developed by Dr. Wright.

We need sodium, just in the right balance with other minerals. A lack of sodium stresses the adrenals also.

 

As an FYI, my ENT waived the requirement that I take antibiotics prophylactically after surgery.   I had concluded that the evidence did not support this practice but fortunately, he agreed to this without my having to challenge him on that issue.  I also think I could have skipped them being used during surgery but unfortunately, because I hadn't done the research on whether that was necessary or not, I told him to go ahead with them which unfortunately, caused a horrible post op reaction of severe burning in the vaginal area and vomiting.   

 

Anyway, you might want to see if your ENT will waive this requirement.  Unfortunately, I ran onto many who aren't willing because of the extremely minute chance of developing an infection.   But it is my understanding that if you know the signs to look for, you can still get an antibiotic prescribed to have on hand to take in case this situation occurs which is what I did.

 

With sleep apnea, be careful about opiate pain killers as they can worsen your condition.   I found Tylenol #3 to be completely adequate for my pain control but if it isn't, you might want to ask about other alternatives.

 

Best of luck.

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rudymoon

The OP in this topic makes reference to using clonidine tablets for a 10% taper. Can someone direct me to an explanation of how it's possible to perform so precise a procedure on so small a dose, .1 or .2mg? I really need some help with this.

 

Thanks,

 

-Rudy

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csm2014

The OP in this topic makes reference to using clonidine tablets for a 10% taper. Can someone direct me to an explanation of how it's possible to perform so precise a procedure on so small a dose, .1 or .2mg? I really need some help with this.

 

Thanks,

 

-Rudy

OP here. Been a while since anyone responded to this thread and saw your inquiry pop up in my box. Yours is a great question and one I feel obligated to address since I'm the one who suggested it and would not wish what I went through on my worst enemy. Unfortunately, I was railroaded from attempting any sort of sensible taper using clonidine tablets at the time to having to resort to clonazepam and lamotrigine as a means of stabilizing my CNS that the clonidine totally disrupted. As I have learned from tapering smaller tablets such as lamotrigine, it's the tablet weight that is the relevant element in a successful taper, not the weight of the active ingredient, e.g., I weighed some spare clonidine 0.1mg tablets I still had left over. The average tablet weight is 91mg which is plenty of weight from which to commence a dry cut (thanks to the huge amount of non-active fillers, binders and excipients that make up the majority as is the case with just about all meds), preferably using a analytical balance that measures in the mg range (0.0001g). If cost is a factor, one can purchase a consumer balance such as the Gemini for a fraction of the cost but realize that it is less accurate and measures in the 0.001g range, but many swear by it and manage to get through their tapers successfully. My scale allows me to taper down to a dry cut weight of  approx. 1mg which would equate to 1.098% (0.01098mg) of the original tablet weight (assuming your tapering 0.1mg of clonidine and assuming your tablet weight is the same as mine). That's approx. 11% of the original active dose of 0.1mg. I use a pharmacy-grade tablet crusher that pulverizes the tablets into a fine powder which I then mix to ensure homogeneity of the active ingredient. From there, I then weigh out the powder for each dose and then encapsulate the powder into a small gelatin or vegetable capsule, re-weighing it to make sure it is exact. I make up the designated amount of capsules all at once for a specific cut and I'm done. It's laborious, but as accurate as any compounding pharmacy could manage.

 

The other option that many others have used successfully is a liquid taper which allows for even further decrements if warranted in cases of extreme protracted PAWS/destabilization/hypersensitivity. Many will likely never need to cut to such minuscule decrements, but at least the option is there if you need it. You can search the forum for some very in-depth protocols on doing a liquid taper. The only caveat would be is the uncertainty as to whether clonidine is water soluble. If not, you'd be better off sticking to dry cutting, IMO. I would personally prefer dry cutting for this reason.

 

So are you also having difficulty getting off clonidine? I'd sure like to know if others are also having difficultly. At least if you're on tablets, you have a chance. I was using a transdermal patch which should be banned altogether, as there's no conceivable way to taper a patch. As for oral clonidine, it should only be administered in emergency situations, i.e. hypertensive crisis, and never as a first line hypertensive agent. Not surprisingly, since my withdrawal issues started over 2 years back, my former prescribing physician had been sanctioned by the state medical board for inappropriate treatment and over-prescribing a variety of controlled substances for one patient who came forward. Who knows how many others, like myself, just moved on.

 

Best of luck and hope this helps. :D

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scallywag

Rudy -- to get a small dose of a medication in a liquid, the simplest way is to increase the amount of water.

 

Sometimes for simplicity with antidepressants or other psych drugs we suggest using the same number of millilitres of water as the dose of the tablet or capsule. For example, a 50 mg tablet in 50 ml of water yields a solution where 1 ml of the solution = 1 mg of the medication.

 

When your dose is 0.1 mg, that arithmetic makes dosing difficult, as you've concluded. ;)

 

If you dissolve the clonidine tablet (or powder from the capsule) in 100 ml of water, the resulting liquid will contain 0.001 mg of clonidine per ml of solution. With this solution, to obtain a dose of 0.09 mg you would need 90 ml of the solution. A subsequent 10% cut from 0.09 is 0.081, so you would need 81 ml of the solution.

 

Hope that helps.

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rudymoon

Hi there

 

My clonidine story is here:

 

http://survivingantidepressants.org/index.php?/topic/13016-rudymoon-quit-drinking-ten-months-ago/

 

To summarize:

 

I was prescribed the drug originally for emergencies at .2mg. There were a couple of periods in May when I had to take it almost daily for a week.

 

Then things really laid down until late July. I took the med off and on for about a week, and had the scrip changed to .1mg as the .2 took my BP too low.

 

I took clonidine daily for 19 consecutive days in August.

 

Then my BP stabilized and I went off the drug for 16 consecutive days.

 

In the midst of the above, I took about 19 300mg doses of gabapentin, the last 12 on consecutive days as I ceased the clonidine.

 

However, I had a bad reaction to the gabapentin and was told by the doc to discontinue the drug.

 

5 days after my last dose of gabapentin, my BP began to spike above 180/100.

 

I've taken clonidine every day since, 10 days total last night.

 

Now, I need off of the med.

 

I've tried multi-med cocktails to control my BP but they were a total flop.

 

I'd reinstate the gabapentin, but might experience a seizure.

 

The clonidine is making my eye problems much worse.

 

And there you have it. :(

 

Thanks for responding,

 

-Rudy

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rudymoon

 

Rudy -- to get a small dose of a medication in a liquid, the simplest way is to increase the amount of water.Sometimes for simplicity with antidepressants or other psych drugs we suggest using the same number of millilitres of water as the dose of the tablet or capsule. For example, a 50 mg tablet in 50 ml of water yields a solution where 1 ml of the solution = 1 mg of the medication.When your dose is 0.1 mg, that arithmetic makes dosing difficult, as you've concluded. ;)If you dissolve the clonidine tablet (or powder from the capsule) in 100 ml of water, the resulting liquid will contain 0.001 mg of clonidine per ml of solution. With this solution, to obtain a dose of 0.09 mg you would need 90 ml of the solution. A subsequent 10% cut from 0.09 is 0.081, so you would need 81 ml of the solution.Hope that helps.

Thanks,

 

Saw your post in the other forum.

 

I'll try and find a syringe today.

 

I'm still a little shaky on the solution concept.

 

My concern is that the concentration might be uneven.

 

Hah, nothing can go wrong! ;)

 

-Rudy

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scallywag

 

Clonidine hydrochloride, USP is an odorless, bitter, white, crystalline substance soluble in water and alcohol

source: drugs[dot]com

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rudymoon

 

 

Clonidine hydrochloride, USP is an odorless, bitter, white, crystalline substance soluble in water and alcohol

 

source: drugs[dot]com
That's some good news, although I'll likely pass on the alcohol! ;)

 

--Rudy

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JanCarol

An excellent & thorough article posted elsewhere by Skeeter:

http://mentalhealthdaily.com/2014/05/22/clonidine-withdrawal-symptoms-high-blood-pressure-increased-heart-rate/

 

Quote:

Despite the fact that this is a relatively safe drug, most professionals do not forewarn patients about prospective withdrawal symptoms. One of the more dangerous withdrawal symptoms is that of major increases in blood pressure. A person can actually go into a “hypertensive crisis” if they quit this drug cold turkey; this could lead to a stroke. Although most people will withdraw from this drug without problems, it is important to be as safe as possible.

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Skeeter

I ended up doing a ton of research on tapering clonidine and found some links that others might find helpful when trying to taper.  Scallywag posted the most informative link I found, which I will also post last below  just so they are all in one post, however, I did find other helpful information, so I will post a couple other links below,  in the hope that they will help someone.

 

While doing my research, the question came up as to how long do you need to take clonidine before there is a need to taper off as per your doctor's instructions (vs stopping cold turkey)?  The answer I found is that even if you only used it for several days to assist with the symptoms of withdrawing off of another medication, you still may need to taper off of clonidine. Only your doctor can tell you how.

 

This first link is a somewhat long conversation between a online patient and a physician.  If you are suffering from any cognitive impairment due to meds or lack of sleep, it may be a harder read than other articles.  Many doctors seem to want to use Bystolic when tapering someone off of clonidine.  The majority of the information says NOT to use it when tapering off of clonidine.  The doctor does address this, I believe, and does give other drugs that can be used.  If your doc suggests Bystolic, please do yourself a favor and read up on it and clonidine and before you begin taking it. It has been known to cause issues, enough so that there is a lot of information available online.  Your doc may tell you that they have had great results combining these 2 medications, but this is your body, not your doc's!

http://www.healthcaremagic.com/premiumquestions/How-to-taper-off-Clonidine/99302

 

A short abstract on using labetalol while discontinuing clonidine:

https://www.ncbi.nlm.nih.gov/pubmed/6273179

 

 

This link is the best at explaining how to taper clonidine, look at the second paragraph under "#1".  This IS a repeat of the link Scallywag posted above, FYI:

http://mentalhealthdaily.com/2014/05/22/clonidine-withdrawal-symptoms-high-blood-pressure-increased-heart-rate/

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csm2014

I ended up doing a ton of research on tapering clonidine and found some links that others might find helpful when trying to taper.  Scallywag posted the most informative link I found, which I will also post last below  just so they are all in one post, however, I did find other helpful information, so I will post a couple other links below,  in the hope that they will help someone.

 

While doing my research, the question came up as to how long do you need to take clonidine before there is a need to taper off as per your doctor's instructions (vs stopping cold turkey)?  The answer I found is that even if you only used it for several days to assist with the symptoms of withdrawing off of another medication, you still may need to taper off of clonidine. Only your doctor can tell you how.

 

This first link is a somewhat long conversation between a online patient and a physician.  If you are suffering from any cognitive impairment due to meds or lack of sleep, it may be a harder read than other articles.  Many doctors seem to want to use Bystolic when tapering someone off of clonidine.  The majority of the information says NOT to use it when tapering off of clonidine.  The doctor does address this, I believe, and does give other drugs that can be used.  If your doc suggests Bystolic, please do yourself a favor and read up on it and clonidine and before you begin taking it. It has been known to cause issues, enough so that there is a lot of information available online.  Your doc may tell you that they have had great results combining these 2 medications, but this is your body, not your doc's!

http://www.healthcaremagic.com/premiumquestions/How-to-taper-off-Clonidine/99302

 

A short abstract on using labetalol while discontinuing clonidine:

https://www.ncbi.nlm.nih.gov/pubmed/6273179

 

 

This link is the best at explaining how to taper clonidine, look at the second paragraph under "#1".  This IS a repeat of the link Scallywag posted above, FYI:

http://mentalhealthdaily.com/2014/05/22/clonidine-withdrawal-symptoms-high-blood-pressure-increased-heart-rate/

 

I am glad I started this thread, my only regret being the proverbial "hindsight is 20/20" rearing its ugly head 2+ years since the trauma of events the discontinuation of this drug caused. At the very least, the data posted since has helped me achieve closure as to what the real cause was, that I was not going insane and otherwise healthy, and that such data can only help prevent others from falling into the same abyss, the cloinidine being a terrible drug that essentially has the capacity to completely disrupt an otherwise intact CNS. 

 

Coincidentally, that long-winded patient in the link you posted is none other than yours truly reaching out in a fit of desperation during my crisis back in 2014! Where on earth did you find that?

 

I did a few of those online doctor posts when I couldn't eat, sleep or otherwise function in between visits to the ER lol.  To be honest, I don't recall the contraindication regarding the Bystolic, although it must've been based on some research I culled, otherwise I wouldn't have cited it. I just can't recall now. In fact, after subsequent research, propanolol (not my favorite beta blocker in that it causes its own PAWS as it upregulates beta adrenergic receptors) has been employed in withdrawal management of psychoactive drugs such as clonidine and benzodiazepines. I am an advocate of using the following meds in withdrawal management: NOTHING. It is my opinion that the least symptomatic, most damaged-controlled method to taper is not by substitution of other drugs to ease withdrawal sx (that have their own set of withdrawal issues, thus digging yourself into a deeper hole), but by strict adherence to the gradual tapers as suggested by this forum. Certain OTC supplements can help in the management of such tapers, but even those must be very carefully tested, one at a time, at fractional dosing and titration, and must NOT be GABA agonists.

 

The takeaway line from the doc in the chat and the line I hear from every doc I tell my story to:

"We do not prescribe clonidine as first line or even second line drug. We use it only as a last add on drug."

 

And to quote one last statement from the well-meaning online doc: "No, I will not use benzodiazipines in most such cases,"

 

Alas, too late now, as I slowly taper off clonazepam as THE only agent that was able to finally suppress the clonidine PAWS that spiraled out of control. Had I received the proper tapering schedule as outlined in this forum, I may have saved myself from going this unfortunate route. But at least I now know how to taper safely. Slow and steady is winning the race!

 

Live and Learn.

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Skeeter

CSM,

I am SO glad that you got through this! It is so interesting that this well informed patient (that is exactly what I thought when I read it!!) is you in that post- what a coincidence...lol. It was a very easy post for me to find (it is not generally so easy to find such well informed patients asking great questions). Thrilled to find your post!! Good job!

 

To save some searching, here is some info regarding clonidine and Bystolic if your doc suggests only this med to help your taper.

Ask your doctor for other meds that might be a better match for you if you are concerned. Due to how Bystolic works, it is specifically not suggested to be used while tapering clonidine. The specific details are very technical, so I will not go into them here, but the 2 meds together during the taper can cause even more severe rebound hypertension than weaning clonidine slowly on its own.

 

Below I have included some very basic info about Bystolic and Clonidine- the second link has a general warning about stopping beta blockers before tapering clonidine:

 

Specific interaction warning between clonidine and Bystolic:

http://www.webmd.com/drugs/2/drug-149883/bystolic-oral/details/list-interaction-details/dmid-203/dmtitle-beta-blockers-clonidine/intrtype-drug

 

Info from drugs.com, important info is quoted in full below regarding beta-blockers and clonidine to save you some time:

QUOTE:

Under "Discontinuing therapy"

"Discontinue the β-adrenergic blocker several days before clonidine therapy is discontinued if patient is receiving clonidine and a β-adrenergic blocking agent concomitantly"

Note: Bystolic is considered to be a beta blocker, aka "β-adrenergic blocker" (specifically a β1-adrenergic receptor blocker)

https://www.drugs.com/monograph/clonidine.html

 

I hope this helps anyone in this situation!

Skeeter

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