The major therapeutic use of clonidine (catapres, others) is in the treatment of hypertension (see Chapter 32). Clonidine also has apparent efficacy in the off-label treatment of a range of other disorders: reducing diarrhea in some diabetic patients with autonomic neuropathy; treating and preparing addicted subjects for withdrawal (see Chapter 23); ameliorating some of the adverse sympathetic nervous activity associated with withdrawal, and decreasing craving for the drug. Transdermal administration of clonidine (catapres-tts) may be useful in reducing the incidence of menopausal hot flashes.
The capacity of clonidine to activate postsynaptic a2 receptors in vascular smooth muscle has been exploited in a limited number of patients whose autonomic failure is so severe that reflex sympathetic responses on standing are absent; postural hypotension is thus marked. Since the central effect of clonidine on blood pressure is unimportant in these patients, the drug can elevate blood pressure and improve the symptoms of postural hypotension. Among the other off-label uses of clonidine are atrial fibrillation, attention-deficit/hyperactivity disorder (ADHD), constitutional growth delay in children, cyclosporine-associated nephrotoxicity, Tourette's syndrome, hyper-hidrosis, mania, posthepatic neuralgia, psychosis, restless leg syndrome, ulcerative colitis, and allergy-induced inflammatory reactions in patients with extrinsic asthma.
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