Clonidine Addiction: Signs and Side Effects of Clonidine Abuse

Clonidine is a prescription medication used to treat high blood pressure, manage ADHD, and help with opioid withdrawal. However, its sedative and calming effects have led to increasing misuse, especially among those using it to recover from opioid addiction withdrawal symptoms.

Many people don’t recognize Clonidine misuse as an issue because of the drug’s status as a prescription medication with fewer restrictions than controlled substances, but misusing Clonidine can have serious and even life-threatening consequences.

This article explores the legitimate dangers, warning signs, and long-term side effects of clonidine misuse.

Clonidine addiction is not an official diagnosis or term in the diagnostic manuals like the DSM. In theory, it could lead to an addiction because of the way it interacts with the central nervous system (CNS), particularly as an alpha-2 adrenergic agonist and because it has sedating effects. Clonidine activates alpha-2 receptors in the brain, which triggers a wave of sedative, calming, and euphoric effects. These pleasant feelings can cause some people to misuse clonidine.

Clonidine is occasionally misused along with other drugs because it may be able to enhance the high of opioids or offset the effects of withdrawal from opioids, benzodiazepines, and other drugs.

Clonidine is not heavily restricted and is, therefore, easier to get and misuse than other sedating medications without immediately raising red flags. This may be why it is one of the more commonly misused medications, as a substitution for more rewarding illicit drugs when not available.

There’s a difference between occasional or recreational misuse and full-blown drug addiction. Knowing the difference can allow individuals to catch warning signs early and get treatment as soon as possible. Although it is clear that people misuse clonidine, it is not clear that it is common for people to develop an addiction to clonidine. That said, addiction is certainly a possibility to watch out for.

Misuse may look like:

• Occasional non-prescribed use: Sometimes using the drug recreationally or without a prescription
• Unapproved doses: Using clonidine in some way other than as prescribed, such as at a higher or more frequent dose
• Use with other substances: Taking clonidine to enhance the effects or reduce the side effects of other substances
• Self-medicating: Using clonidine to manage self-diagnosed conditions or conditions the drug was not approved to treat

Some behavioral signs of addiction (known as “Use Disorder” in the Diagnostic and Statistical Manual) include:

• Compulsive use: Using clonidine repeatedly, even when it causes problems
• Drug-seeking behavior: Engaging in acts like doctor shopping or getting clonidine illegally
• Neglecting responsibilities: Failing to adequately keep up with work and social responsibilities due to drug use
• Tolerance: Developing a tolerance to clonidine, where more of the drug is needed to achieve the same effects
• Inability to quit: Trying and failing to stop using clonidine
• Withdrawal: Experiencing negative physical symptoms after stopping use

Although clonidine addiction is not a problem with a defined frequency and severity so far, studies show it is misused, and misusing clonidine without a prescription can have serious consequences for one’s health and well-being.

Yes. Using clonidine for a long time or at high doses can cause physical and psychological dependence. However, there is a difference between dependence and addiction.

Physical dependence is when the body adapts to the presence of clonidine and eventually requires the drug to function normally. Without clonidine, physically dependent individuals often experience negative side effects (withdrawal symptoms). In the case of clonidine, the most dangerous withdrawal symptom is called “rebound hypertension,” which is a rapid increase in blood pressure that may cause damage to several organ systems in the body (heart, brain, kidneys, etc.).

Psychological dependence happens when someone develops an emotional or mental reliance on clonidine, which can involve feeling anxiety and other negative emotions when they don’t have the drug or feeling like they need clonidine to cope with everyday stressors.

It’s important to recognize the many behavioral, psychological, and physical warning signs that indicate someone has an addiction, if you’re worried about clonidine misuse or addiction in a friend or family member.

Behavioral Signs:

• Doctor shopping
• Forging prescriptions
• Taking a medication more often or at higher doses than prescribed
• Neglecting responsibilities
• Hiding or lying about the medication use
• Spending excessive time or money to get more medication
• Continuing to use the drug despite negative consequences
• Mixing the medication with other substances

Physical Signs:

• Excessive drowsiness or sedation
• Withdrawal when attempting to stop using the medication
• Signs of low blood pressure (often feeling dizzy or lightheaded or fainting)
• Abnormally slow heart rate (bradycardia)
• Difficulty balancing or trouble with motor skills
• Rapid increases in blood pressure (due to withdrawal)

Psychological Signs:

• Obsession with using clonidine or getting more
• Anxiety or panic when clonidine isn’t available
• Mood swings and irritability
• Depression or numbness
• Losing interest in things one used to enjoy

Anyone who feels like they can’t stop using clonidine, even after previous attempts or harmful consequences, should seek professional guidance concerning potential clonidine misuse or addiction.

Clonidine withdrawal symptoms usually begin 12-48 hours after the last dose and may last several days to weeks. These symptoms often cause discomfort, but can also be dangerous, so stopping clonidine requires careful medical supervision.

Common Clonidine withdrawal symptoms include:

• Nervousness or agitation
• Insomnia
• Headaches
• Shaking or tremors
• Profuse sweating
• Nausea and vomiting
• Chills
• Muscle aches
• Depression
• Elevated blood pressure
• Rapid heart rate
• Palpitations

Severe or dangerous withdrawal symptoms include:

• Significant spike in blood pressure (rebound hypertension)
• Chest pain
• Hallucinations
• Extreme confusion or disorientation
• Extreme agitation or restlessness

Signs of a medical emergency from clonidine withdrawal include:

• Severe chest pain
• Difficulty breathing
• Confusion, slurred speech, and weakness
• Going unconscious
• Severe hypertension

Clonidine withdrawal should always be taken seriously. Use of the drug should only be stopped while under close medical supervision because of the risk of stroke, heart attack, and other severe life-altering or life-threatening conditions.

Misusing clonidine can lead to serious short-term and long-term side effects.

Short-term side effects of clonidine misuse can appear almost immediately or within minutes to hours of taking the substance, and can be mild to severe.

Short-term clonidine misuse side effects include:

• Severely low blood pressure (hypotension) and fainting
• Abnormally slow heart rate (bradycardia)
• Irregular heartbeats (cardiac arrhythmias)
• Reduced blood flow to the brain, causing fainting
• Severe drowsiness
• Confusion or disorientation
• Depression and mood changes
• Hallucinations
• Slowed breathing
• Difficulty breathing

Long-term misuse of clonidine can result in side effects that appear over weeks, months, or even years. Like with short-term side effects, these conditions can range from side effects that may not develop into a serious problem for decades to potentially fatal medical emergencies.

Long-term clonidine misuse side effects include:

• Chronic hypotension
• Heart rhythm disorders
• Increased risk of falls
• Chronic constipation and other bowel problems
• Digestive issues like nausea and abdominal pain
• Changes in appetite, causing weight loss or gain
• Chronic depression
• Sleep disorders
• Trouble remembering or concentrating

Clonidine overdose is a serious health risk, especially when the drug is combined with other central nervous system depressants such as alcohol, opioids, and barbiturates.

Overdose risks include:

• Severe low blood pressure
• Respiratory depression (slow breathing)
• Loss of consciousness
• Cardiac arrest
• Coma

Clonidine enhances the effects of other drugs, and in the case of CNS depressants, this can lead to severe conditions like potentially fatal respiratory depression. Any signs of overdose or other serious side effects should be treated as a medical emergency.

Several factors can contribute to an individual’s risk of developing an addiction to a prescription medication like clonidine. While these factors don’t determine who will become addicted to the substance, being aware of them can help individuals stay more vigilant to signs of misuse or addiction.

Key clonidine addiction risk factors include:

• Co-occurring mental health conditions: Mental health disorders such as anxiety, PTSD, and ADHD can cause individuals to misuse medications because their calming effects reduce the distress caused by these issues. In addition, ADHD patients may take advantage of a clonidine prescription in particular since it’s prescribed for that mental health problem..
• Previous substance use disorders: Those with a history of addiction to opioids, alcohol, or other substances are at an increased risk of developing an addiction to a medication. This can be especially true for clonidine for those recovering from opioid addiction, since clonidine is sometimes used to treat withdrawal symptoms.
• Polysubstance abuse: Mixing clonidine and other prescription medications with other drugs like opioids or alcohol enhances the effects of these substances, potentially increasing the likelihood of further misuse, dependence, and addiction.
• Family history: Both genetic predisposition to addiction disorders and being in an environment where clonidine or other prescription medication misuse is normalized or encouraged can significantly increase the risk of someone misusing and becoming addicted to a prescription drug.
• Easy access to prescriptions: Those with multiple healthcare providers, more lenient providers, or access to someone with a prescription medication will increase the risk that they misuse or develop an addiction to it
• Young age: Individuals ages 18-25 have higher rates of prescription drug abuse. Young adults and teens are often more open to experimenting with medications, and developing brains are more vulnerable to the effects of drug use, making them more prone to addiction.

It’s important to mention any known risk factors to healthcare providers when being assessed for a potential substance abuse disorder so they can work with the individual to make a more effective recovery plan.

Even though clonidine addiction is not a well-described entity, misuse of the medication is not uncommon, and providers and family members should watch for the possibility of clonidine addiction in their patients. Healthcare providers use several assessment methods and a standard set of criteria, generally from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to diagnose clonidine addiction. In the DSM-5, clonidine addiction would most likely fit into the Sedative, Hypnotic, or Anxiolytic Use Disorder category.

The DSM-5 lists 11 possible criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder. An individual must meet two of these criteria within a 12-month period to be diagnosed.

The DSM-5 criteria for a Sedative, Hypnotic, or Anxiolytic use disorder diagnosis are:

1. Taking the Sedative, Hyponotic or Anxiolytic in larger doses or for a longer period than prescribed
2. Trying to cut down on or stop the Sedative, Hypnotic, or Anxiolytic use, but being unable to
3. Spending an extensive amount of time trying to obtain, use, or recover from the Sedative, Hypnotic, or Anxiolytic
4. Having cravings or a strong desire to use the substance
5. Failing to fulfill important obligations at work, school, or home because of Sedative, Hypnotic, or Anxiolytic use
6. Continuing to use despite constant social or interpersonal problems caused or made worse by the Sedative, Hypnotic, or Anxiolytic
7. Giving up or reducing important activities because of the Sedative, Hypnotic, or Anxiolytic use
8. Continually using a Sedative, Hypnotic, or Anxiolytic in physically unsafe situations
9. Continuing to use despite often experiencing negative consequences from doing so
10. Developed physical tolerance to Sedative, Hypnotic, or Anxiolytic
11. Experiencing withdrawal when a Sedative, Hypnotic, or Anxiolytic isn’t taken

A Sedative, Hypnotic, or Anxiolytic Use Disorder can be diagnosed as:

• Mild: 2-3 criteria met
• Moderate: 4-5 criteria
• Severe: 6 or more criteria

Healthcare providers generally conduct a thorough examination of an individual beyond looking at the DSM-5 before diagnosing them with a substance use disorder.

Other assessment components may involve:

• Review of medical history: A review of the individual’s previous medications, noting dosage or frequency changes, a history of multiple prescriptions from different providers, and any experiences with addiction treatment in the past.
• Physical examination: Assessing the patient’s vital signs (blood pressure, heart rate, etc.), neurological, cardiovascular, and general physical health.
• Psychological evaluation: Evaluating the individual’s general mental state, testing for co-occurring mental health disorders, cognitive function, and any significant behavioral changes.
• Lab testing: Drug screening for clonidine and other substances, a complete metabolic panel to check health, and cardiac testing to check for any effects clonidine misuse might have had on the heart or blood vessels.
• Behavioral assessment: Evaluating the individual’s pattern of medication use, any trouble functioning at work, school, relationships, etc., any previous attempts to stop, and evidence of drug-seeking behavior.
• Family and social assessment: Exploring the impact clonidine use has had on the individual’s family and other relationships, as well as assessing their current support system, troubling environmental factors, and any work or academic consequences they may have suffered because of clonidine use.
• Specialized assessments: Healthcare providers may use standardized screening tools like the CAGE-AID questionnaire for prescription drugs, the Screening Tool of Addiction Risk (STAR), and the Current Opioid Misuse Measure (COMM) for suspected poly-substance use.
• Differential diagnosis: Clinicians must distinguish clonidine addiction from other behaviors, such as appropriate medical use where the individual developed a tolerance to clonidine, another substance use disorder, certain mental health conditions, and other medical conditions.

Getting a professional diagnosis is also important to help determine the severity of one’s clonidine addiction. Assessing the severity, identifying co-occurring conditions, exploring the individual’s current environmental and social situation, etc., helps health professionals make an accurate diagnosis and an effective recovery plan.

If you or someone you love is struggling with clonidine misuse or if you’re concerned about addiction, don’t hesitate to seek support. Addiction is a medical condition that is often successfully managed with professional support. Even though Clonidine is a prescription medication that is not a controlled substance, some people misuse it, which could theoretically lead to addiction. Attempting to detox without medical supervision is dangerous.

If you are struggling to control or stop your clonidine use, help is available. RehabNet is a free, confidential resource backed by an experienced team that understands the unique challenges of prescription drug addiction. They can help you find a suitable treatment center tailored to your needs.

Don’t hesitate to reach out and take the next step in your recovery journey. Contact RehabNet today.