Does Clonidine Help with Alcohol Withdrawal?

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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Is Clonidine Helpful for Alcohol Withdrawal?

Clonidine is a drug doctors typically prescribe to treat high blood pressure. Classified as an antihypertensive, clonidine affects nerve impulses in the brain, helping the blood vessels relax and facilitating better blood flow. Doctors also use clonidine to treat attention deficit hyperactivity disoerder (ADHD). In addition, clonidine may ease symptoms of alcohol withdrawal syndrome (AWS) when used in conjunction with other medications like diazepam.

What Is Clonidine?

Clonidine is an alpha-2 agonist with similarities to epinephrine, methoxamine, and pseudoephedrine. Alpha-2 agonist drugs work in different ways to relieve specific issues, such as pressure on the eyes, blood vessel constriction, sinus congestion, and shock. Clonidine also relieves but does not cure high blood pressure.

Medical professionals first used clonidine in 1966 to treat hypertension. In addition, doctors sometimes prescribe clonidine to ease the symptoms of migraine headaches. As an anesthetic, it acts as a sedative, an analgesic, and/or an anti-anxiety medication.

The generic name for this drug is clonidine hydrochloride. It comes in tablet form with various strengths. It also comes in liquid form for IV applications or as a patch worn on the skin. It is fast-acting, lowering your blood pressure within an hour of taking it. With a bioavailability of 100%, this medication is reliably effective for its intended use.

Off-label applications of clonidine include opiate and alcohol withdrawal management. Doctors sometimes prescribe clonidine for PTSD, sleep difficulties, or to control menopause symptoms.

How Does Clonidine Help During Alcohol Withdrawal?

During alcohol withdrawal, you may experience a spike in blood pressure, which clonidine will address. Clonidine may also relax your body and relieve pain throughout the withdrawal process.

Clonidine as a Sedative

Clonidine, in conjunction with other medications, helps you stay calmer and eases symptoms like:

  • Delirium tremens
  • Seizures
  • Hallucinations
  • Hyperexcitability
  • Anxiety
  • Sleep problems
  • Agitation
  • Irritability

The calming effects of a drug like clonidine are particularly important for those at a higher risk for delirium tremens. The mortality rate for clients experiencing DT averages around 8%. Some of the factors that put you at an increased risk for DT are as follows:

  • Older age
  • Comorbidities
  • History of psychosis
  • Past alcohol withdrawals
  • History of seizures
  • Dehydration

Clonidine As a Pain Reducer

As an alpha-2 agonist, clonidine helps relieve pain in clinical settings. For example, the use of clonidine in intensive care, along with local anesthetics, provides pain relief for patients using breathing tubes. It has also played a role in treating chronic pain.

Clonidine helps patients bypass the daunting side effects of opioids, such as slowing down heart and respiratory rates to dangerous lows. While opioids are highly addictive, clonidine tends to be safer over short-term, medically monitored use.

What Are the Side Effects of Clonidine?

When your doctor prescribes clonidine as part of your alcohol withdrawal program, you can expect some mild or moderate side effects, including:

  • Drowsiness
  • Lightheadedness
  • Dry mouth
  • Headaches
  • Constipation
  • Sleep disruption
  • Depression

These side effects do not all affect everyone taking clonidine. They tend to occur most often in older individuals. In addition, they may appear when you first begin taking the drug but will ease up after your body acclimates.

Some more serious side effects are possible with clonidine use. These consist of heart palpitations, confusion, hallucinations, and digestive distress. Discuss the potential side effects of clonidine with your doctor before starting treatment.

Who Can Take Clonidine Safely and Who Cannot?

Clonidine is likely to be beneficial to you if you are healthy and over 18 years old. A medical professional may prescribe this medication for a younger person but only on rare occasions.

If you have experienced an allergic reaction to clonidine in the past, you should not take it. Also, if you have an existing heart condition or a kidney disease, your doctor will likely prescribe an alternate treatment.

Those who are trying to become pregnant, are pregnant, or are nursing should avoid taking clonidine. Although there is little data showing any adverse effects on an embryo or infant, there is also a lack of positive evidence.

If you have a blood circulation issue in your extremities, clonidine could exacerbate it. A past stroke or other brain bleeding issues, including an aneurysm, may disqualify you from taking clonidine for alcohol withdrawal syndrome.

How Clonidine Interacts With Other Alcohol Withdrawal Medications

Signs of alcohol withdrawal syndrome may appear just a few hours after a client quits drinking. More severe symptoms start within the first 24 hours of a person’s last drink. Therefore, prompt treatment with prescription medication is crucial in managing these symptoms.

The medications of choice for managing alcohol withdrawal syndrome are typically benzodiazepines, such as diazepam, lorazepam, and chlordiazepoxide. They are proven to be safe and effective for AWS treatment. If managed carefully by a medical professional, they present a low likelihood of addiction, so they do not replace one dependency with another. Different types of benzodiazepines are equally effective in treating AWS, so supply is rarely an issue.

If alcohol use disorder is a client’s primary health concern, benzodiazepines, such as diazepam and chlordiazepoxide, provide longer-lasting symptom relief. Clients who are at a higher risk for severe withdrawal symptoms, such as liver dysfunction or lung disease, can take a short-acting benzodiazepine like lorazepam to minimize adverse effects on their existing health issues.

While benzodiazepine may be the most common and effective medication for treating AWS, clonidine can also play a critical role in the process. In most cases, you can safely take it along with benzodiazepines in a medically prescribed regimen during alcohol withdrawal.

Along with benzodiazepines, clonidine helps significantly reduce serious symptoms by slowing the heart rate and reducing blood pressure. However, the data does not support the idea that clonidine alone prevents delirium or seizures.

Availability of Clonidine for Alcohol Withdrawal Syndrome

Pharmaceuticals that serve multiple purposes sometimes end up in short supply. This is true of clonidine in recent years. In 2023, Boehringer Ingelheim followed up past recalls of its drug Catapres, the brand name for clonidine hydrochloride, with a discontinuation of the medication altogether.

The reason for the recalled batches was not a problem with the efficacy of the drug but rather a problem with Catapres production. Although Boehringer Ingelheim’s decision to stop making Catapres caused a shortage of the branded drug, enough generic preparations were available to fill the demand.

Doctors have a choice of several similar medications in designing an AWS treatment regimen, and clonidine is not always part of the program. It is important to trust the judgment of your medical professionals to prescribe the medications that will be most effective for your individual situation.

Inpatient Alcohol Withdrawal

Inpatient treatment for alcohol withdrawal syndrome provides clients with 24-hour supervision, treatment, and assistance throughout the difficult detox period. Especially in cases of long-term alcohol use, a history of seizures, or repeated attempts at alcohol withdrawal, inpatient care may be the best option.

Inpatient treatment consists of a combination of medications to reduce the symptoms of withdrawal. This is likely to include clonidine to help keep the client’s heart rate and blood pressure from spiking to health-threatening levels during the withdrawal period. In cases where the client has existing cardiovascular issues, inpatient treatment provides continuous monitoring and treatment for acute symptoms.

Outpatient Alcohol Withdrawal

For withdrawal from shorter-term alcohol dependency and milder symptoms, outpatient treatment can be an equally effective, less constricting alternative.

When getting AWS treatment as an outpatient, you will still have medical care, such as regular appointments with your treatment team and therapy sessions, but you will return home at night. If you are otherwise healthy, have the support of family or friends, and have a stable home life, you will probably do well with outpatient treatment.

With the help of safe medications to reduce your symptoms, including drugs like diazepam and clonidine, mild to moderate AWS is manageable for many clients on an outpatient basis. If you have struggled with remaining off alcohol after rehab or if your symptoms prove to be more severe than expected, you always have the option of intensive outpatient treatment, which includes more therapy than a normal outpatient experience. Partial hospitalization in conjunction with outpatient treatment is another alternative. Discuss a treatment plan with your rehab specialist or doctor to find a program that will work the best for you.

Is Clonidine Addictive?

While not as common as opioid or amphetamine addiction, clonidine addiction may occur. As a drug with fewer restrictions than opioids, clonidine is not as difficult to obtain and therefore more available in non-prescription settings.

Signs of clonidine dependency include:

  • An intense craving for the drug
  • An ongoing need for clonidine after treatment
  • A regular increase in the dosage
  • Withdrawal symptoms like nausea, headache, insomnia, and/or anxiety

By sticking with your prescribed dosage and following your physician’s instructions, you can avoid becoming dependent on clonidine. If you experience symptoms of clonidine withdrawal, seek treatment from a qualified medical professional.

Conclusion

A holistic approach to alcohol withdrawal should address your physical, mental, and emotional needs with a combination of proven strategies. These may include one or more medications that effectively reduce your symptoms, whether mild or severe, to get you safely through the detox process. Clonidine is one of the medications that works with other tested drugs to help reduce the health-threatening symptoms of alcohol withdrawal syndrome. 

If you are ready to take the first step toward an alcohol-free lifestyle, contact our free alcoholism hotline at 855-955-0771. Our trained counselors are standing by to give you the support you need to start treatment.