Catapres (Clonidine) as Anxiety Treatment: Does it Work? Pros and Cons

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Clonidine is a prescription medication that belongs to the class of drugs called central alpha-2 receptor agonists. It was originally approved for treating high blood pressure, but it has also been used for other conditions such as attention deficit hyperactivity disorder (ADHD), opioid withdrawal, menopausal symptoms, and chronic pain 1. Clonidine is available as an oral tablet, an extended-release tablet, and a transdermal patch.

Clonidine was first synthesized in 1962 by Janssen Pharmaceutica, a Belgian company. It was initially developed as a nasal decongestant, but it was found to have potent antihypertensive effects 2. Clonidine was approved by the FDA in 1974 for the treatment of hypertension 3. Since then, clonidine has been investigated for various off-label uses, such as anxiety disorders, ADHD, and opioid withdrawal 4.

Clonidine works by stimulating the alpha-2 adrenergic receptors in the brain and spinal cord. These receptors are involved in regulating the release of norepinephrine, a neurotransmitter that mediates the stress response and anxiety 5. By activating these receptors, clonidine reduces the amount of norepinephrine in the nervous system, which leads to a decrease in blood pressure, heart rate, and anxiety levels 6.

Clonidine is not approved by the FDA for the treatment of anxiety disorders, but it has been prescribed off-label for this purpose by some clinicians. There is limited evidence to support the effectiveness of clonidine for anxiety, and most of the studies are small, short-term, or uncontrolled .

Some of the conditions that clonidine has been used for include:

• Post-traumatic stress disorder (PTSD): Clonidine may help reduce nightmares, insomnia, and hyperarousal symptoms in patients with PTSD . However, clonidine is not effective for treating other PTSD symptoms such as flashbacks, avoidance, or emotional numbing .
• Generalized anxiety disorder (GAD): Clonidine may have some benefit for patients with GAD who have comorbid hypertension or insomnia . However, clonidine is not superior to placebo or other anxiolytics for reducing anxiety symptoms in GAD .
• Panic disorder: Clonidine may reduce the frequency and severity of panic attacks in patients with panic disorder . However, clonidine is not effective for preventing panic attacks or improving agoraphobia .
• Social anxiety disorder (SAD): Clonidine may improve social performance and reduce physiological arousal in patients with SAD. However, clonidine is not effective for reducing social anxiety or fear of negative evaluation.

The dosing of clonidine for anxiety depends on the formulation, the condition being treated, and the patient’s response. The following are some general guidelines:

• Oral tablet: The usual starting dose is 0.1 mg twice daily. The dose can be increased by 0.1 mg every week until the desired effect is achieved. The maximum dose is 0.6 mg per day .
• Extended-release tablet: The usual starting dose is 0.1 mg once daily at bedtime. The dose can be increased by 0.1 mg every week until the desired effect is achieved. The maximum dose is 0.4 mg per day .
• Transdermal patch: The usual starting dose is one patch (0.1 mg/24 hours) applied to a hairless area of skin every 7 days. The dose can be increased by adding another patch (0.1 mg/24 hours) every week until the desired effect is achieved. The maximum dose is four patches (0.4 mg/24 hours) per week .

Clonidine should be taken as directed by the doctor and should not be stopped abruptly without medical supervision. Stopping clonidine suddenly can cause a rebound increase in blood pressure, heart rate, and anxiety.

Clonidine can cause various side effects, some of which are more common than others. The most common side effects include:

• Drowsiness
• Dizziness
• Dry mouth
• Constipation
• Headache
• Fatigue
• Skin irritation (with patch)

Some of the less common but more serious side effects include:

• Low blood pressure
• Slow heart rate
• Fainting
• Depression
• Confusion
• Hallucinations
• Allergic reaction

Clonidine should be used with caution in patients with:

• Heart disease or arrhythmia
• Kidney disease or dialysis
• History of stroke or transient ischemic attack
• Pheochromocytoma (a rare tumor of the adrenal gland)
• Pregnancy or breastfeeding

Clonidine may interact with other medications, such as:

• Beta blockers (e.g., atenolol, metoprolol)
• Antidepressants (e.g., fluoxetine, sertraline)
• Opioids (e.g., morphine, oxycodone)
• Alcohol and sedatives (e.g., diazepam, zolpidem)

Patients should inform their doctor of all the medications they are taking before starting clonidine.

Some of the potential benefits of using clonidine for anxiety include:

• It can lower blood pressure and heart rate, which may be beneficial for patients with hypertension or cardiovascular risk factors .
• It can improve sleep quality and reduce nightmares, which may be helpful for patients with PTSD or insomnia .
• It can reduce physical symptoms of anxiety, such as sweating, trembling, or palpitations .
• It can be used as an adjunct to other treatments, such as psychotherapy or other medications.
• It is relatively inexpensive and widely available.

Some of the potential drawbacks of using clonidine for anxiety include:

• It has limited evidence for its efficacy and safety for anxiety disorders, and it is not approved by the FDA for this indication .
• It can cause various side effects, some of which can be serious or bothersome .
• It can cause withdrawal symptoms if discontinued abruptly, which can worsen anxiety and blood pressure .
• It can interact with other medications, which may increase the risk of adverse effects or reduce the effectiveness of either drug .
• It can impair cognitive and psychomotor performance, which may affect driving, work, or school.

Clonidine is a medication that can lower blood pressure and reduce anxiety by stimulating the alpha-2 receptors in the brain. However, clonidine is not approved by the FDA for the treatment of anxiety disorders, and it has limited evidence for its effectiveness and safety for this purpose. Clonidine can also cause various side effects and interactions, and it should not be stopped abruptly without medical supervision. Therefore, clonidine should be used with caution and under the guidance of a doctor for patients with anxiety. Clonidine may be more suitable for patients who have comorbid hypertension, insomnia, or PTSD-related nightmares, and who do not respond to or tolerate other treatments.

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2: Clonidine - an overview | ScienceDirect Topics

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5: Clonidine For Anxiety - Dosage & Side Effects - Drug Genius

6: Clonidine For Anxiety: Benefits, Dosage and Reviews

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