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  • clonodine

    Hi I would like to know who has tried clonodine? I am looking for something that wont have a bad effect in combination to epinepherine aka epi pens for allergic reactions. clonodine is it a beta blocker cause i cant use those. also i saw that there is over 600 drug interactions with clonodine and was wondering why there is so many interactions thats just insane
    please tell me your experience with this medicine. cause i really need something and cant use beta blockers thanks so much

  • #2
    Hi cnaemily,

    clonidine is a blood pressure lowering medication that tends to shut down the smaller blood vessels in the extremities (hands, feet and face). It can be quite effective in relieving the flushing but has to be taken on a daily basis for some time to see the full effect. you can get some side effects at the beginning (feeling tired, dizzy, dry mouth...) but it usually disappears after a couple of weeks. I don'tknow about interaction with other drugs and the best is to see with your GP as you anyway need a prescription to get it. The dose you take depends on the severity of the flushing. I have been taking clonidine for almost 2 years now and it's been helping me a lot, though less now. If you enter "clonidine" in the top right search box, you'll get loads of information about it.
    Best.
    Marie

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    • #3
      clonidine is not a beta blocker its an antidepressant which acts centrally on the brain ....loering blood pressure.... propanalol is a beta blocker used for rosacea...

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      • #4
        Originally posted by shoaib View Post
        clonidine is not a beta blocker its an antidepressant which acts centrally on the brain ....loering blood pressure.... propanalol is a beta blocker used for rosacea...
        Nope, think you are confused with remeron ;)

        Clonidine is indeed a blood pressure lowering drug, like propranolol and betablockers, but they work slightly different.
        My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

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        • #5
          clonidine

          yes thank u, I did read it was a blood pressure medication. I also read it interacts with so many things which is scary! I just really hope I find something to get rid of this flushing cause its bad!

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          • #6
            Clonidine has very complex effects on the autonomic system, both centrally and peripherally which, to be honest, really aren't well understood even by experts. You are correct to say it interacts with a lot of drugs, one of the reasons that even though it can be very effective at helping with flushing, it should be prescribed very cautiously and always under the scrutiny of your GP (even then, I've found they don't understand the problem).

            Re. combining clonidine with medications that raise levels of epinephrine/norepinephrine (including other rosacea treatments such as betablockers, many common antidepressants or even the adrenalin used in dental anaesthetics etc), then yes it's possible it could interact to raise your blood pressure, as the centrally-acting aspect of the drug that lowers blood-pressure is overridden by the extra adrenalin, and the peripheral alpha-agonism effects combine with the pressor effect of the adrenalin to raise blood pressure.
            Last edited by y-gwair; 7 February 2013, 08:32 PM.

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            • #7
              Originally posted by y-gwair View Post
              Re. combining clonidine with medications that raise levels of epinephrine/norepinephrine (including other rosacea treatments such as betablockers, many common antidepressants or even the adrenalin used in dental anaesthetics etc), then yes it's possible it could interact to raise your blood pressure, as the centrally-acting aspect of the drug that lowers blood-pressure is overridden by the extra adrenalin, and the peripheral alpha-agonism effects combine with the pressor effect of the adrenalin to raise blood pressure.
              This information might be correct for the combo of epinepherine with rosacea medications like clonidine/propranolol/antidepressants etc. I don't know much about epinepherine.

              Apart from that and by itself, (am no specialist) you seem to state that propranolol raises the level of epinephrine/norepinephrine, and can increase adrenaline in the body. And that common antidepressants do this as well. And that therefore the blood pressure can actually be raised instead of lowered, when combined with clonidine.

              But propranolol actually blocks the action of epinephrine and norepinephrine on both β1- and β2-adrenergic receptors (see wiki and others). Also, propranolol blocks the release of adrenaline to a degree, not raise it. So I don't understand your post.. :/
              Dr Chu prescribes the two together and I have used them for the past 7 years together and have low blood pressure, not too low, just stable on the low end. It never raised to high blood pressure and I have a home kit to test.

              Clonidine and remeron (the antidepressant) does counteract, but I asked my pharmacist and Dr Chu about this at the time, and at the low dose that is prescribed for rosacea (usually the starting dose of 15 mg, as this works best for flushing), they both said there is usually no such risk, and at best the remeron would neutralize the blood pressure lowering actions of the clonidine. They might be wrong.. I just never had the problems you described. Anyone using these combinations of meds is always wise to keep an eye on blood pressure and general side effects, but to put things in perspective; these medications are prescribed by rosacea specialists and they are all meds that are usually well tollerated and that have been relatively safely prescribed for a long time (remeron is the newest of the bunch though).

              From what I read, remeron/mirtazapine doesn't actually unnaturally 'raise' the level of epinephrine/norepinephrine in the brain. It enhances the serotonin and noradrenaline that is naturally produced by the brain and that is blocked in depressed people by alpha-2 receptors on the nerve cells in the brain, by blocking these receptors (so that the serotonin and noradrenaline are released again in the brain).

              "Mirtazapine works in the brain, where it enhances the effect of naturally occurring chemicals called neurotransmitters. These are chemical compounds that act as chemical messengers between nerve cells. Noradrenaline and serotonin are two such neurotransmitters and have various functions that we know of. When noradrenaline and serotonin are released from nerve cells in the brain they act to lighten mood. When they are bound to nerve cells in the brain, they no longer have an effect on mood. It is thought that when depression occurs, there may be a decreased amount of noradrenaline and serotonin released from nerve cells in the brain. Mirtazapine works by blocking receptors called alpha-2 receptors that are found on nerve cells in the brain. Noradrenaline and serotonin would normally bind to these receptors. By blocking them, mirtazapine prevents noradrenaline and serotonin from becoming bound to the nerve cells. This enhances the mood-lightening effect of free noradrenaline and serotonin that is released from nerve cells, and helps relieve depression."
              http://www.netdoctor.co.uk/depressio...#ixzz2K8rYrPOM

              Like I said, I might be wrong but this is the information I have and discussed with my specialists..

              best wishes Nat
              Last edited by nat007; 7 February 2013, 09:46 PM.
              My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

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              • #8
                [QUOTE=nat007;278074elf, (am no specialist) you seem to state that propranolol raises the level of epinephrine/norepinephrine, and can increase adrenaline in the body. And that common antidepressants do this as well. And that therefore the blood pressure can actually be raised instead of lowered, when combined with clonidine.

                But propranolol actually blocks the action of epinephrine and norepinephrine on both β1- and β2-adrenergic receptors (see wiki and others). Also, propranolol blocks the release of adrenaline to a degree, not raise it. So I don't understand your post.. :/
                Dr Chu prescribes the two together and I have used them for the past 7 years together and have low blood pressure, not too low, just stable on the low end. It never raised to high blood pressure and I have a home kit to test.[/QUOTE]

                No, I didn't say that propranolol raises adrenalin. Propranolol blocks the effect of epinephrine at betareceptors, not just those in heart tissue (beta 1) but those in peripheral blood vessels (beta 2). However, because it blocks peripheral betareceptors in blood vessels all over your body, this can increase levels of norepinephrine in blood vessel nerve synapses, so also acts as an indirect alpha agonist. Clonidine is also an alpha 2 agonist, and so two drugs can combine forces to constrict blood vessels quite strongly, which can then raise blood pressure. Since combining these two drugs, my blood pressure has actually gone up quite a bit, and the flushing and facial pain has actually got worse. This was also the case when Chu was piling on these drugs last year, the facial problem just got worse and worse, as did my tachycardia until I started fainting and keeling over.

                The autonomic nervous system is a very complex thing, and drugs that interfere with it's function can affect people very differently depending of the sensitivity of their nerves to the various vascular neurotransmitters. I'm currently seeing autonomic nervous system specialists at two London teaching hospitals, they are very cautious about putting patients on any of these drugs without testing their heart/autonomic function first, far more cautious than Prof Chu, who doesn't even take a baseline blood pressure reading before prescribing drugs that could affect BP and heart rate quite radically, particularly in complex combinations. My point is that one should always be very cautious when taking different drugs together, always check with your GP, check your BP regularly whilst on them, and read the leaflet that comes with the drug to check for possible interactions.
                Last edited by y-gwair; 8 February 2013, 01:01 PM.

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                • #9
                  Originally posted by y-gwair View Post
                  No, I didn't say that propranolol raises adrenalin. Propranolol blocks the effect of epinephrine at betareceptors, not just those in heart tissue (beta 1) but those in peripheral blood vessels (beta 2). However, because it blocks peripheral betareceptors in blood vessels all over your body, this can increase levels of norepinephrine in blood vessel nerve synapses, so also acts as an indirect alpha agonist. Clonidine is also an alpha 2 agonist, and so two drugs can combine forces to constrict blood vessels quite strongly, which can then raise blood pressure. Since combining these two drugs, my blood pressure has actually gone up quite a bit, and the flushing and facial pain has actually got worse. This was also the case when Chu was piling on these drugs last year, the facial problem just got worse and worse, as did my tachycardia until I started fainting and keeling over.

                  The autonomic nervous system is a very complex thing, and drugs that interfere with it's function can affect people very differently depending of the sensitivity of their nerves to the various vascular neurotransmitters. I'm currently seeing autonomic nervous system specialists at two London teaching hospitals, they are very cautious about putting patients on any of these drugs without testing their heart/autonomic function first, far more cautious than Prof Chu, who doesn't even take a baseline blood pressure reading before prescribing drugs that could affect BP and heart rate quite radically, particularly in complex combinations. My point is that one should always be very cautious when taking different drugs together, always check with your GP, check your BP regularly whilst on them, and read the leaflet that comes with the drug to check for possible interactions.

                  Thanks for the explanation.. I still don't really understand it though :S
                  From what I was told and have read, and forgive me if I just don't get it here, both propranolol and clonidine are supposed to lower blood pressure. I understood that they do this, just roughly and not in science terms speaking here, by dilating the bigger arteries around the heart. So they partially are vasodilators, but by lowering the blood pressure that way (bigger arteries are wider), The pressure goes off the smaller blood vessels and especially those in the extremities, hence cooler faces and also often cold hands and feet (and increased Raynauds symptoms sometimes for those suffering with that, incl me). So I still don´t understand how propranolol or clonidine alone, or them both combined, can raise the blood pressure.

                  I understand that you have a very complex and delicate case of rosacea with other nerve problems perhaps going on (forgive me if I use the wrong medical terms here), and I wonder how much of that can have to do with your high blood pressure response? There might be more people experiencing high blood pressure from these meds, I haven´t notice them but also haven´t looked for them yet. I do know that I know of quite a few people who use the combo of clonidine and propranolol or another beta blocker for that matter without such high blood pressure problems. So I email this mainly to comfort any future user of these meds to not freak out yet. You might be right that some people get the high blood pressure as a result of combining these meds, but it is certainly not a given and I still don´t really understand why this happened to you. But I am sorry that it did and that another flushing treatment seems off the list for you

                  I am a patient of Chu and he did suggest to test the blood pressure regularly and see if it stayed within the normal-low end range and to also have a base liver check up every so many years and general blood work. I have these with my regular GP and closer to home dermatologist, who all are willing to work together to some degree. I agree with you that one should always be cautious when embarkking on medication and to be careful with evaluating it´s full effects, not just on the symptoms they were prescribed for.

                  Best wishes
                  My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                  Comment


                  • #10
                    Originally posted by nat007 View Post
                    Thanks for the explanation.. I still don't really understand it though :S
                    From what I was told and have read, and forgive me if I just don't get it here, both propranolol and clonidine are supposed to lower blood pressure. I understood that they do this, just roughly and not in science terms speaking here, by dilating the bigger arteries around the heart. So they partially are vasodilators, but by lowering the blood pressure that way (bigger arteries are wider), The pressure goes off the smaller blood vessels and especially those in the extremities, hence cooler faces and also often cold hands and feet (and increased Raynauds symptoms sometimes for those suffering with that, incl me). So I still don´t understand how propranolol or clonidine alone, or them both combined, can raise the blood pressure.
                    What you are describing is reflex peripheral vasoconstriction, which is a general effect of most betablockers, including those like atenolol that are selective for beta 1 receptors which are found mainly around the heart. Propranolol affects both beta 1 and beta 2 receptors, which are found in blood vessels throughout the body. To quote wikipedia:

                    "Research has also shown that propranolol has inhibitory effects on the norepinephrine transporter and/or stimulates norepinephrine release (present experiments have shown that the concentration of norepinephrine is increased in the synapse but do not have the ability to discern which effect is taking place).Since propranolol blocks β-adrenoceptors, the increase in synaptic norepinephrine only results in α-adrenergic activation, with the α1-adrenoceptor being particularly important for effects observed in animal models. Therefore, some have suggested that it be looked upon as an indirect α1 agonist as well as a β antagonist. "

                    Alpha agonists increase blood pressure by simulating the effect of norepinephrine on the receptors that narrow blood vessels. Clonidine is an alpha 2 agonist, which means that it also narrows blood vessels. As it also lowers BP by tricking the brain into stimulating less norepinephrine from the adrenal glands, the effect in most people is that these two different effects cancel each other out, but this isn't necessarily the case if you take other medications that interact to alter this balance, including propranolol, over-the-counter drugs like pseudoephedrine, dental adrenalin, neuropathic painkillers such as nortriptyline etc etc.

                    I think most people who suffer flushing/burning face problems, so-called 'vascular rosacea', probably have some level of autonomic disturbance and hypersensitivity to neurotransmitters. For most people, this will probably just be localised nerve damage/supersensitivity to neurotransmitters in the face, but for a minority of people like myself it may also be symptomatic of a wider problem that they might not be aware of until they start taking complex combinations of blood pressure drugs.
                    Last edited by y-gwair; 13 February 2013, 06:29 PM.

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                    • #11
                      Ok, interesting.. I never realized this interaction between clonidine and propranolol. Sorry for sounding really dim here, but I'm a foreigner and no med student and find it hard to fully grasp what you are quoting. Would you be so kind to explain it in children's language? I just don't understand it fully.

                      Propranolol is prescribed for high blood pressure patients, but it has the potential to actually raise blood pressure only further, due to it's simulation of the effect of norepinephrine on the receptors that narrow blood vessels? Does it have this dual action mode by itself (and if so, what sane doctor would prescribe it then for people with risky high blood pressure? I know at least 3 elderly relatives or friends who use it for that purpose), or only when combined with another blood pressure lowering med, like clonidine? If the two cancel each others effect out, would it be wise then to stop with one of the two (when someone takes both propranolol and clonidne for facial flushing for instance)? To avoid extra redness and high blood pressure risk?

                      Thanks for your input, best wishes
                      My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                      Comment


                      • #12
                        Originally posted by y-gwair View Post
                        What you are describing is reflex peripheral vasoconstriction, which is a general effect of most betablockers, including those like atenolol that are selective for beta 1 receptors which are found mainly around the heart. Propranolol affects both beta 1 and beta 2 receptors, which are found in blood vessels throughout the body. To quote wikipedia:

                        "Research has also shown that propranolol has inhibitory effects on the norepinephrine transporter and/or stimulates norepinephrine release (present experiments have shown that the concentration of norepinephrine is increased in the synapse but do not have the ability to discern which effect is taking place).Since propranolol blocks β-adrenoceptors, the increase in synaptic norepinephrine only results in α-adrenergic activation, with the α1-adrenoceptor being particularly important for effects observed in animal models. Therefore, some have suggested that it be looked upon as an indirect α1 agonist as well as a β antagonist. "

                        Alpha agonists increase blood pressure by simulating the effect of norepinephrine on the receptors that narrow blood vessels. Clonidine is an alpha 2 agonist, which means that it also narrows blood vessels. As it also lowers BP by tricking the brain into stimulating less norepinephrine from the adrenal glands, the effect in most people is that these two different effects cancel each other out, but this isn't necessarily the case if you take other medications that interact to alter this balance, including propranolol, over-the-counter drugs like pseudoephedrine, dental adrenalin, neuropathic painkillers such as nortriptyline etc etc.

                        I think most people who suffer flushing/burning face problems, so-called 'vascular rosacea', probably have some level of autonomic disturbance and hypersensitivity to neurotransmitters. For most people, this will probably just be localised nerve damage/supersensitivity to neurotransmitters in the face, but for a minority of people like myself it may also be symptomatic of a wider problem that they might not be aware of until they start taking complex combinations of blood pressure drugs.


                        This is an old post, but I came back onto it again. Looked for some science to back this up but I can't find it. I did come across this research:


                        "Interaction of clonidine and beta-blockers.
                        Lilja M, et al. Acta Med Scand. 1980.
                        Show full citation
                        Abstract
                        On the hypothesis that non-selective beta-blockers can antagonize or reverse the antihypertensive effect of clonidine (C), 12 hypertensive outpatients were treated with C alone and in combination with propranolol (P), atenolol (A) and prazosin (Pz). C alone (0.11 or 0.22 mg b.i.d.) or in combination with P (80 mg b.i.d.) did not provide normotension. Changing P to A (50 mg b.i.d.) reduced supine systolic and diastolic pressures, which now were significantly lower (p less than 0.01) than during C alone. Changing A to P again resulted in elevated pressures. Pz (1 mg t.i.d.) added to the C+P regimen lowered supine blood pressures to the levels otherwise recorded during C+A. C dose-dependently contracted rabbit aortic spiral in vitro, reaching about 50% of maximum responses to noradrenaline. Pz abolished this response. P (0.1--10 micrograms/ml) but not A somewhat enhanced responses to high doses of C. Sotalol rather antagonized C contractions. We conclude that A but not P enhances the antihypertensive action of C. No hypertensive interaction was observed."
                        https://www.ncbi.nlm.nih.gov/m/pubmed/6102839/


                        Clonidine and the vasodilating beta blocker antihypertensive drug interaction.
                        Pettinger WA, Mitchell HC, Güllner HG.
                        Abstract
                        Because propranolol is contraindicated in some patients and since clonidine can decrease heart rate and renin release, clonidine was substituted for propranolol in 14 severely hypertensive minoxidil-treated outpatients. Clonidine induced weight loss which, since plasma concentrations were not suppressed, was not due to inhibition of release of antidiuretic hormone or renin. These endocrine interrelations were confirmed by later administration of clonidine to 4 of the subjects under controlled circumstances in our General Clinical Research Center. When substituted for propranolol, clonidine controlled blood pressure and heart rate in 8 of the 9 outpatients whose blood pressure had been previously well controlled. Clonidine and propranolol had additive antihypertensive effects in the other 5 patients. Thus, clonidine can substitute for propranolol or when added to the propranolol-vasodilator combination supply an additional blood pressure-lowering effects. This substitution or addition results in an increase in side effects. In addition, clonidine has a diuretic action under these circumstances by an unknown mechanism.
                        https://www.ncbi.nlm.nih.gov/pubmed/18312

                        Long-term experience with the combination of clonidine and beta-adrenoceptor blocking agents in hypertension.
                        Vanholder R, Lameire N, Ringoir S.
                        Abstract
                        The risk of cardiovascular and fatal complications and the antihypertensive effect of a clonidine-beta-blocker combination was studied in 98 patients and was compared with the results for a group of patients treated with other antihypertensive regimens. The profile of complications was similar in the two groups for a total follow-up period of more than 2000 treatment-months. Clonidine in combination either with propranolol or atenolol had a distinct antihypertensive effect. However, clonidine plus atenolol resulted in a more immediate and pronounced fall in blood pressure. It is concluded that the combination of clonidine and a beta-blocker is an effective antihypertensive medication, and that patients treated with it are apparently at no greater risk of serious cardiovascular incidents than are those treated with other regimens.


                        I wonder if the blood pressure increasing effects you mentioned Y-gwair, when combining the two, is a more rare side-effect perhaps? Like serotonin syndrome that sometimes happens when combining certain antidepressants, but not always? I take propranolol and clonidine together for severe flushing and burning since 2006 and have low-normal blood pressure. Lower than before starting (not higher) but not dangerously low either.

                        Anyway, an old post but caught my attention again.
                        My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

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