CLONIDEX

Clonidine hydrochloride, USP is a centrally acting alpha-agonist hypotensive agent available as tablets for oral administration in three dosage strengths: 0.1 mg, 0.2 mg, and 0.3 mg. The 0.1 mg tablet is equivalent to 0.087 mg of the free base.

The following inactive ingredients are contained in these products: corn starch, D&C Yellow #10 Aluminum Lake, FD&C Yellow #6 Aluminum Lake (Sunset Yellow Lake), lactose monohydrate, magnesium stearate, and sodium starch glycolate.

Clonidine hydrochloride, USP is an imidazoline derivative and exists as a mesomeric compound.

The chemical name is 2-(2,6-dichlorophenylamino)-2-imidazoline hydrochloride.

The following is the structural formula

Clonidine hydrochloride, USP is an odorless, bitter, white, crystalline substance soluble in water and alcohol. 18ddb7fd-figure-01.

Clonidine hydrochloride tablets are indicated in the treatment of hypertension.

Clonidine hydrochloride tablets may be employed alone or concomitantly with other antihypertensive agents.

Lactation History of asthma Anuria

Collision, history Pregnancy, first 3 months (of) Severe hepatic impairment Severe renal impairment Nephropathy Digestive pathology, history Elderly Allergic Subject debility Nephrotoxic treatment in progress Extended treatment.

Clonidine stimulates alpha-adrenoreceptors in the brain stem.

This action results in reduced sympathetic outflow from the central nervous system and in decreases in peripheral resistance, renal vascular resistance, heart rate, and blood pressure.

Clonidine hydrochloride tablets act relatively rapidly.

The patient’s blood pressure declines within to 60 minutes after an oral dose, the maximum decrease occurring within to 4 hours.

Renal blood flow and glomerular filtration rate remain essentially unchanged.

Normal postural reflexes are intact; therefore, orthostatic symptoms are mild and infrequent.

Acute studies with clonidine hydrochloride in humans have demonstrated a moderate reduction (15% to 20%) of cardiac output in the supine position with no change in the peripheral resistance: at a 45 degree tilt there is a smaller reduction in cardiac output and a decrease of peripheral resistance.

During long term therapy, cardiac output tends to return to control values, while peripheral resistance remains decreased.

Slowing of the pulse rate has been observed in most patients given clonidine, but the drug does not alter normal hemodynamic response to exercise.

Tolerance to the antihypertensive effect may develop in some patients, necessitating a reevaluation of therapy.

Other studies in patients have provided evidence of a reduction in plasma renin activity and in the excretion of aldosterone and catecholamines.

The exact relationship of these pharmacologic actions to the antihypertensive effect of clonidine has not been fully elucidated.

Clonidine acutely stimulates growth hormone release in both children and adults, but does not produce a chronic elevation of growth hormone with long-term use.

The pharmacokinetics of clonidine is dose-proportional in the range of 100 mcg to 600 mcg. The absolute bioavailability of clonidine on oral administration is 70% to 80%.

Peak plasma clonidine levels are attained in approximately to 3 hours.

Following intravenous administration, clonidine displays biphasic disposition with a distribution half-life of about 20 minutes and an elimination half-life ranging from to 16 hours.

The half-life increases up to 41 hours in patients with severe impairment of renal function.

Clonidine crosses the placental barrier.

It has been shown to cross the blood-brain barrier in rats.

Following oral administration about 40% to 60% of the absorbed dose is recovered in the urine as unchanged drug in 24 hours.

About 50% of the absorbed dose is metabolized in the liver.

Neither food nor the race of the patient influences the pharmacokinetics of clonidine.

The antihypertensive effect is reached at plasma concentrations between about 0.2 and 2.0 ng/mL in patients with normal excretory function.

A further rise in the plasma levels will not enhance the antihypertensive effect.

Mechanism of action

Clindamycin is an antibiotic antibiotic of the lincosamide family.

It has a mainly bacteriostatic action against Gram+ aerobic bacteria and a wide spectrum of anaerobic bacteria.

Critical concentrations separate the sensitive strains of the intermediate strains and the latter from the resistant ones: S 2 mg/l.

Sensitive species

Gram+ aerobic bacteria: Bacillus cereus, Corynebacterium diphtheriae, Enterococcus faecium, erysipelothrix, staphylococcus metis-S, staphylococcus metis-R, streptococcus b, streptococcus nongroupable, streptococcus, streptrophythium, cholepticus pyogenes, aerobics aerobics aerobics, aberobostress, arbobes, arborambust, arborambust, arborambust, arborambust, arborams, arborams, arb.

• Liver status (abnormality) (Common)
• Eosinophilia Neutropenia Urticaria (Uncommon)
• Maculopapulous eruption (Uncommon)
• Morbilliform eruption Generalised acute exanthemous pusulosis
• Exfoliative dermatitis Lyell's syndrome Toxic epidermal necrolysis Stevens-Johnson Syndrome
• Pruritus Bully dermatosis Polymorphic Erythema Vaginal infection Thrombocytopenia
• Thrombocytopenic Purpura Leucopenia Agranulocytosis Ictery Anaphylactoid reaction
• Anaphylactic shock Anaphylactic reaction Hypersensitivity Angioedema Oedema of Quincke
• DRESS syndrome Dysgueusia Abdominal pain (Common)
• Pseudomembranous colitis (Common)
• Diarrhoea (Common)
• Nausea (Uncommon)
• Vomiting (Uncommon)
• Clostridioidal colitis difficult (formerly Clostridium difficile)
• Esophagus Ulcer Esophagitis Acute nephropathy.

Hypertension may develop early and may be followed by hypotension, bradycardia, respiratory depression, hypothermia, drowsiness, decreased or absent reflexes, weakness, irritability and miosis.

The frequency of

CNS depression may be higher in children than adults.

Large overdoses may result in reversible cardiac conduction defects or dysrhythmias, apnea, coma and seizures.

Signs and symptoms of overdose generally occur within 30 minutes to two hours after exposure.

As little as 0.1 mg of clonidine has produced signs of toxicity in children.

There is no specific antidote for clonidine overdosage.

Clonidine overdosage may result in the rapid development of CNS depression; therefore, induction of vomiting with ipecac syrup is not recommended.

Gastric lavage may be indicated following recent and/or large ingestions.

Administration of activated charcoal and/or a cathartic may be beneficial.

Supportive care may include atropine sulfate for bradycardia, intravenous fluids and/or vasopressor agents for hypotension and vasodilators for hypertension.

Naloxone may be a useful adjunct for the management of clonidine-induced respiratory depression, hypotension and/or coma; blood pressure should be monitored since the administration of naloxone has occasionally resulted in paradoxical hypertension.

Tolazoline administration has yielded inconsistent results and is not recommended as first-line therapy.

Dialysis is not likely to significantly enhance the elimination of clonidine.

The largest overdose reported to date involved a 28-year old male who ingested 100 mg of clonidine hydrochloride powder.

This patient developed hypertension followed by hypotension, bradycardia, apnea, hallucinations, semicoma, and premature ventricular contractions.

The patient fully recovered after intensive treatment.

Plasma clonidine levels were 60 ng/mL after 1 hour, 190 ng/mL after 1.5 hours, 370 ng/mL after 2 hours, and 120 ng/mL after 5.5 and 6.5 hours.

In mice and rats, the oral LD of clonidine is and 465 mg/kg, respectively.

Patients should be instructed not to discontinue therapy without consulting their physician.

Sudden cessation of clonidine treatment has, in some cases, resulted in symptoms such as nervousness, agitation, headache, and tremor accompanied or followed by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma.

The likelihood of such reactions to discontinuation of clonidine therapy appears to be greater after administration of higher doses or continuation of concomitant beta-blocker treatment and special caution is therefore advised in these situations.

Rare instances of hypertensive encephalopathy, cerebrovascular accidents and death have been reported after clonidine withdrawal.

When discontinuing therapy with clonidine hydrochloride tablets, the physician should reduce the dose gradually over to 4 days to avoid withdrawal symptomatology.

An excessive rise in blood pressure following discontinuation of clonidine hydrochloride tablets therapy can be reversed by administration of oral clonidine hydrochloride or by intravenous phentolamine.

If therapy is to be discontinued in patients receiving a beta-blocker and clonidine concurrently, the beta-blocker should be withdrawn several days before the gradual discontinuation of clonidine hydrochloride tablets.

Because children commonly have gastrointestinal illnesses that lead to vomiting, they may be particularly susceptible to hypertensive episodes resulting from abrupt inability to take medication.

Clonidine hydrochloride tablets should not be used in patients with known hypersensitivity to clonidine.

The dose of clonidine hydrochloride tablets must be adjusted according to the patient’s individual blood pressure response.

The following is a general guide to its administration.

Dose: 0.1 mg tablet twice daily (morning and bedtime).

Elderly patients may benefit from a lower initial dose.

Further increments of 0.1 mg per day may be made at weekly intervals if necessary until the desired response is achieved.

Taking the larger portion of the oral daily dose at bedtime may minimize transient adjustment effects of dry mouth and drowsiness.

The therapeutic doses most commonly employed have ranged from 0.2 mg to 0.6 mg per day given in divided doses.

Studies have indicated that 2.4 mg is the maximum effective daily dose, but doses as high as this have rarely been employed.

Patients with renal impairment may benefit from a lower initial dose.

Patients should be carefully monitored.

Since only a minimal amount of clonidine is removed during routine hemodialysis, there is no need to give supplemental clonidine following dialysis.

For questions regarding this product, call Teva at 1-888-838-2872.

Clonidine hydrochloride tablets, USP are supplied as follows: 0.1 mg — Each orange, round tablet imprinted with R and on one side and bisect on the other side contains 0.1 mg of clonidine hydrochloride, USP and is supplied in NDC: 70518-4342-00 NDC: 70518-4342-01 PACKAGING: 30 in 1 BOTTLE PLASTIC PACKAGING: 30 in 1 BLISTER PACK Dispense in a tight, light-resistant container as defined in the USP.

Store at 25°C (77ºF); excursions permitted to 15º to 30ºC (59º to 86ºF) .

Suite #4 Indiana, PA 1-724-465-8762.

Reproduction studies performed in rabbits at doses up to approximately 3 times the oral maximum recommended daily human dose (MRDHD) of clonidine hydrochloride tablets produced no evidence of a teratogenic or embryotoxic potential in rabbits.

In rats, however, doses as low as 1/3 the oral MRDHD (1/15 the MRDHD on a mg/m 2 basis) of clonidine were associated with increased resorptions in a study in which dams were treated continuously from 2 months prior to mating.

Increased resorptions were not associated with treatment at the same time or at higher dose levels (up to 3 times the oral MRDHD) when the dams were treated on gestation days to 15.

Increases in resorption were observed at much higher dose levels (40 times the oral MRDHD on a mg/kg basis; 4 to 8 times the MRDHD on a mg/m 2 basis) in mice and rats treated on gestation days to 14 (lowest dose employed in the study was 500 mcg/kg).

No adequate, well-controlled studies have been conducted in pregnant women.

Clonidine crosses the placental barrier.

Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

As clonidine hydrochloride is excreted in human milk, caution should be exercised when clonidine hydrochloride tablets are administered to a nursing woman.

Safety and effectiveness in pediatric patients have not been established in adequate and well-controlled trials See WARNINGS, Withdrawal.