Question: Have been struggling to taper off Clonidine since mid Feb. Was on 0.2mg transdermal patch for 5 wks; switched to 0.1mg patch for 10 days. Had 5 withdrawal rebound attacks in that time, the first time when I stopped cold XXXXXXX a couple times when the patch would lose its potency from peeling off, and then when I dropped from 0.2mg to 0.1mg. In each case, BP spiked between 160/95 to 180/100 and had anxiety, tremor tachycardia. I can always tell when my BP is elevated by the surge in anxiety and HR. Doc prescribed Verapamil 80mg TID to help manage the rebound which I soon after stopped, as it didn't help with the rebounds; later added Lisinopril 10mg to no avail, but am still on it. I now am trying to manage weaning off using Clonidine 0.025mg caps I had compounded and still rebounding unless I take no more than every 6 hrs. The idea is to decrease by 0.025mg every few days, but now, I don't know if I will be successful and not rebound. The symptoms overshoot and I have to use a higher dose to stabilize. Doc recommended Bystolic 5mg to use as pre-treatment for managing tapering off the Clonidine, but I read that it can interact w/ Clonidine & magnify the rebound, yet studies show beta blockers being used to deplete the excess catecholamines which are the cause of the rebound effect. Doc says unlikely and that those warnings are in rare cases only. I don't think I can manage without first having another agent on board before I start weaning off. The question is which one and will it be safe? A pharmacist suggested increasing the Lisinopril but again, that may help with lowering BP in general, but will not address the anxiety, etc. My entire well being is tied to this Clonidine demon. If I don't have a steady amount, I will go from being slightly agitated to having full-blown rebound. I am just coming down from a rebound as I write this. I am terrified I will never come off this nasty drug. I feel it has me addicted. Can't believe I am experiencing this with only being on it for less than 60 days. Some people are on this drug for years and at much higher doses. Please advise.

Thanks for the quick response. I am really going through a tough time and regret ever starting this med. The anxiety is insurmountable and prevents me from being to work, etc. To bring you up to date: Yesterday was my first day back on Clonidine after nearly 3 days stopping the 0.1mg patch (was on the patch system for only 48 days). I then rebounded badly again (161/97) yesterday morning. I had to take a total of 0.1mg with my last dose (0.025mg) last evening at around 6pm. By 11pm, I was feeling fairly stable (125/73) and went to sleep, but awoke, rebounding again. So, I am having to always resort to going back on Clonidine to stabilize, despite trying to wean off using the 0.025mg caps. And when I do rebound, I am, now finding that I have to use at the full 0.1mg to stabilize. If I don't, I will rebound again. The severity of rebound is therefore dose-dependent. I am also finding out the hard way that oral Clonidine's duration of action is much less than the patch. To clarify, I had NOT used Bystolic (nebivolol) for fear it would exacerbate the hypertension based on what I had read when it's used with Clonidine. Therefore, I don't know if it would have worked or not, but if I understand you correctly, you are suggesting the opposite of a beta blocker. Questions/Concerns: 1) After reading up on beta 1/beta 2 agonists, I would think they would just exacerbate the rebound hypertension, anxiety, etc. as these are common side effects from these meds? [http://en.wikipedia.org/wiki/Beta-adrenergic_agonist] Please explain how these would act as a receptor blockade, as you say, and not cause a worsening of the rebound. 2) Which beta agonists would you recommend for Clonidine withdrawal? 3) Why would you recommend a DHP CCB over Verapamil which is also a CCB? 4) Which DHP CCB would you recommend? 5) You mention a "combined blocker". Pls explain. 6) Do you suggest to pre-treat using these agents before attempting any tapering off of Clonidine? 7) What can I do in the meantime until a safe and effective agent protocol is implemented with my physician? Go back on the 0.1mg dose of Clonidine once daily - or spread out? 8) Do you think increasing the dose of Lisinopril will help in this case or not? 9) What has been your success rate in using the recommended agents in successfully discontinuing Clonidine and are there any rebound effects associated with such agents themselves? Thanks again.

1) I don't know what's going on now; my rebounds are suddenly getting worse and more frequent (hypertension, panic, tremor, etc.). Today, I stabilize for an hour, taking a dose of 0.025mg, and then find myself rebounding after an hour. I could not sleep for more than 45 min. without taking more Clonidine. It seems it is getting out of hand. This has never occurred before when on the patches. I just took 2 more 0.025mg caps. Why aren't these doses lasting and what do you think is occurring here? 2) Given the above, a slow withdrawal without use of any agents may not be an option. If you advise not to use a beta blocker right away, what do you advise to use? One of the non-DHP CCBs? 3) This link explains that labetolol like all beta blockers can cause worse rebound. This is why I held off on taking Bystolic as well: http://www.webmd.com/drugs/drug-7212-labetalol+oral.aspx?drugid=7212&drugname=labetalol+oral&dmid=203&dmtitle=BETA-BLOCKERS/CLONIDINE&intrtype=DRUG&pagenumber=9 Yet, I am seeing that labetalol has been used to in clonidine rebound: http://www.ncbi.nlm.nih.gov/pubmed/0000 Also, that a beta blocker is a catecholamine-depleting agent. 4) I realize that the CCB help control the rebound hypertension, but will it help reduce the anxiety, etc. as well? If not, the what about using a benzo?

Just curious - why do you suggest a short-acting beta blocker instead of longer acting?