Clonidine for Withdrawal: How It Helps with Opioid and Alcohol Detox

What Is Clonidine?

Clonidine is a common prescription medication available as tablets or patches. The patches and short-acting tablets are FDA-approved for treating high blood pressure. However, the long-acting clonidine tablets are only FDA-approved for treating attention-deficit/hyperactivity disorder.

The short-acting form of clonidine is often prescribed off-label to treat opioid withdrawal symptoms. The drug can also be used to help treat alcohol withdrawal syndrome. 

Is Clonidine a Controlled Substance?

Clonidine is different from some other medications used for medication-assisted treatment (MAT). It’s not classified as a controlled substance. While it’s generally not seen as highly addictive, there is a possibility of developing dependence. The risk is higher when the drug is combined with benzodiazepines, opioids or alcohol.

Clonidine for Withdrawal

Recovery from addiction often comes with powerful cravings and challenging withdrawal symptoms. In some cases, withdrawal symptoms can even be dangerous. In treating alcohol and opioid use disorders, clonidine may be included in a treatment plan. It can help people move from detoxification to the next stage of recovery.

Clonidine for Opioid Withdrawal

Some researchers believe clonidine’s mechanism of action in the brain is what makes it able to treat withdrawal symptoms. During opioid withdrawal, neurotransmitters (chemicals) that excite the brain often increase. This increase can cause withdrawal symptoms to occur.

Clonidine belongs to a class of drugs known as alpha-2 adrenergic agonists. They work on brain neurons that produce noradrenergic brain chemicals. They do so by preventing neurons from releasing these chemicals into the brain. Because these chemicals cause withdrawal symptoms, clonidine helps to prevent and treat withdrawal.

Clonidine can help relieve opioid withdrawal symptoms like: 

• Restlessness, uneasiness and sudden bouts of panic
• Muscular discomfort and pain in the joints
• Teary eyes, a runny nose and flu-like symptoms
• Sweating
• Frequent and excessive yawning
• Difficulty falling asleep or staying asleep
• Stomach cramps, nausea and gastrointestinal distress
• Enlarged pupils

If a patient can find enough relief from symptoms with clonidine, the detox process may be relatively quick. Instead of months, detox could only last a few weeks. Depending on the type and severity of opioid addiction, a healthcare provider might choose to use clonidine. This can be matched with a tapering plan that involves buprenorphine, methadone or other opioid agonists.

Clonidine for Alcohol Withdrawal

Clonidine can also help treat alcohol withdrawal symptoms. This is because alcohol withdrawal and opioid withdrawal cause similar changes in the brain. Clonidine prevents neurotransmitters from releasing noradrenergic chemicals into the brain. In turn, this prevents or treats alcohol withdrawal symptoms.

Clonidine can help alleviate alcohol withdrawal symptoms like:

• Anxiety
• Mild depression
• Sweating
• Tension
• Tremors
• Elevated blood pressure

Clonidine Dosage for Withdrawal

While clonidine is not FDA-approved for withdrawal, it has been studied and is often used for this purpose. However, since there is no FDA approval, the dosage used for withdrawal treatment can vary.

For opioid withdrawal, 0.1 mg to 0.3 mg of clonidine every six to eight hours has been reported. The dose may be adjusted based on how well it controls symptoms. Patients are eventually weaned off of the drug as withdrawal symptoms gradually lessen. For alcohol withdrawal, 0.5 mg of clonidine two or three times daily may help with tremors, heart rate and blood pressure control.

How Effective Is Clonidine for Treating Withdrawal?

Using clonidine for withdrawal is an off-label application of the drug. Experts consider clonidine less effective than first-choice treatments methadone and buprenorphine. Nonetheless, clonidine may have value in people who cannot take the first-choice drugs. Clonidine has been proven effective in significantly reducing the effects of opioid withdrawal. According to the American Journal of Psychiatry, clonidine has been shown to help in recovery. The drug is beneficial in reducing cravings for opioids and prolonging abstinence. 

Clonidine also has demonstrated effectiveness in relieving alcohol withdrawal symptoms. However, it is not broadly thought of as a first-line treatment option for alcohol withdrawal. Benzodiazepines remain the first-choice treatment.

Clonidine versus Other Medications for Withdrawal

Effective MAT for withdrawal will likely include a variety of medications. They will help limit withdrawal symptoms and promote sobriety. Sometimes, a provider may decide that a patient will benefit from taking clonidine with other medications. 

Buprenorphine and methadone are often given as first-choice therapy for opioid detox and withdrawal. The main difference between clonidine and these medications is that clonidine is less effective. It also does not work as an opioid replacement. Methadone, buprenorphine and similar medications work on the opioid receptors in the brain. This is how they can relieve withdrawal and cravings. In contrast, clonidine works by blocking noradrenergic neurotransmitters in the brain. 

Benzodiazepines are also a first-choice therapy for alcohol withdrawal. Benzodiazepines work on the GABA receptors in the brain. In this way, they serve as a substitute or replacement for alcohol. As with opioids, clonidine does not serve to replace stimulation lost from the substance. Instead, this drug relieves symptoms by blocking noradrenergic neurotransmitters. Clonidine can be used alongside benzodiazepines for this purpose.

How Quickly Does Clonidine Work for Withdrawal?

Studies carried out when clonidine was first used for withdrawal showed that the drug “can rapidly suppress the signs and symptoms associated with opiate withdrawal.” Clonidine may act quickly to relieve symptoms. However, the duration of its use will depend on the overall regimen used for opioid detox.  

Is Clonidine Effective for Long-Term Treatment?

Clonidine is often given in the detox phase of treating opioid use disorder to ease withdrawal symptoms. It was first made to lower blood pressure and heart rate. That is why it’s not usually used for long-term opioid use disorder treatment.

Clonidine Side Effects

Clonidine’s side effects are generally mild. The most common side effects are:

• Dry mouth
• Drowsiness
• Dizziness
• Constipation
• Fatigue

Other side effects include:

• Dry throat
• Headache
• Insomnia
• Sexual dysfunction
• Nausea
• Change in taste
• Anxiety

Notably, when clonidine is used for opioid withdrawal, low blood pressure is an additional side effect. This feature often limits the dose a person can take.

Clonidine Interactions

Like all drugs, clonidine has some drug interactions. Medicines that should be used cautiously or avoided with clonidine include:

• Central nervous system depressants: Clonidine may enhance the side effects of sedating drugs. These include alcohol, opioids, benzodiazepines and barbiturates.
• Antipsychotics: Clonidine shares side effects with antipsychotic drugs. These include low blood pressure, dizziness and fatigue. Combining the medications may worsen these side effects.
• Some cardiac medications: Heart and blood pressure medications that impact heart rate may dangerously slow the heart when mixed with clonidine. Examples include digitalis, beta-blockers (metoprolol) and calcium channel blockers (verapamil, diltiazem).

Risks of Clonidine Treatment

Many people can use clonidine safely. However, it should not be suddenly discontinued. Stopping the drug cold turkey can have serious health consequences. These include a rapid rise in blood pressure. This blood pressure spike can lead to a stroke or even death. You may also experience symptoms like agitation, tremors or confusion.

If you need to stop taking clonidine, you should only do so while being closely monitored by your health care provider. Generally, your provider will reduce your dose over several days to safely wean you off the drug.

Abuse Potential

Although clonidine is not a controlled substance, experts believe it has the potential for abuse. Some may start to depend on clonidine mentally while getting treatment for opioid addiction. This happens if they link clonidine with relief from opioid withdrawal. In other cases, people who use opioids or other depressants might take clonidine on purpose to make their high stronger.

Find a Medical Detox Program Near You

If you or someone you love is struggling with alcohol or opioid abuse, help is available. The Recovery Village at Baptist Health can provide evidence-based treatment at any stage of your recovery.

The Recovery Village at Baptist Health offers a range of addiction rehab treatment programs in multiple South Florida locations. The Recovery Village Miami specializes in outpatient treatment services, while The Recovery Village Palm Beach offers a full continuum of care that includes medical detox and inpatient rehab. Contact us today to learn how our qualified medical professionals can help begin the path to a healthier, substance-free life in recovery.