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Clonidine Epidural Injection and Inderal

Determining the interaction of Clonidine Epidural Injection and Inderal and the possibility of their joint administration.

Check result:
Clonidine Epidural Injection <> Inderal
Relevance: 01.08.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using propranolol and cloNIDine together may lower your blood pressure and slow your heart rate. Using these medications together can cause a slow heartbeat, headaches, dizziness, or feeling like you might pass out. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or need your blood pressure checked more often to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Clonidine and beta-blockers may have synergistic pharmacodynamic effects resulting in marked AV block, bradycardia, and hypotension. Conversely, cases of antagonism of hypotensive effects have been reported, the mechanism of which is unknown. In addition, potentiation of the hypertensive rebound associated with abrupt withdrawal of clonidine or both clonidine and the beta blocker may occur. Increased blood pressure, hypertensive crisis, hypertensive encephalopathy, strokes, and fatalities have been reported after clonidine withdrawal. The proposed mechanism is related to increased catecholamine release after clonidine withdrawal, and concurrent beta-blockade results in unopposed alpha-adrenergic effects of the catecholamines, resulting in vasoconstriction. Patients who discontinue clonidine while taking noncardioselective beta blockers appear to be at a higher risk of developing rebound hypertension.

MANAGEMENT: Close monitoring of blood pressure is recommended for patients receiving this combination. Patients should be advised to notify their doctor if they experience a reduced heart rate, dizziness, fainting, or headaches. Clonidine should never be discontinued abruptly, but should be tapered off over 2 to 4 days. The beta blocker should be discontinued a few days before gradually discontinuing the clonidine. It has also been suggested that replacing clonidine and the beta blocker with labetalol (an alpha and beta blocker) may prevent rebound hypertension although some symptoms from increased catecholamine levels occur, or selecting a cardioselective beta blocker (e.g. atenolol, betaxolol, bisoprolol, metoprolol) which is theoretically not expected to exacerbate the pressor response. Patients being withdrawn from clonidine should be carefully monitored for blood pressure changes, severe headache, tremors, apprehension, flushing, nausea, and vomiting.

References
  • Perks D, Fisher GC "Esmolol and clonidine: a possible interaction." Anaesthesia 47 (1992): 533-4
  • Lilja M, Jounela AJ, Juustila H, Mattila MJ "Interaction of clonidine and beta-blockers." Acta Med Scand 207 (1980): 173-6
  • Jounela AJ, Lilja M "Interactions between beta-blockers and clonidine." Ann Clin Res 16 (1984): 181-2
  • Strauss FG, Franklin SS, Lewin AJ, Maxwell MH "Withdrawal of antihypertensive therapy. Hypertensive crisis in renovascular hypertension." JAMA 238 (1977): 1734-6
  • Bailey RR, Neale TJ "Rapid clonidine withdrawal with blood pressure overshoot exaggerated by beta-blockage." Br Med J 1 (1976): 942-3
Clonidine Epidural Injection

Generic Name: clonidine

Brand name: Catapres, Kapvay, Catapres-TTS, Duraclon, Catapres-TTS-1, Catapres-TTS-2, Catapres-TTS-3

Synonyms: Clonidine, CloNIDine

Inderal

Generic Name: propranolol

Brand name: Inderal LA, Inderal XL, InnoPran XL, Inderal, Hemangeol, InnoPran XL

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

Interaction with food and lifestyle