Clonidine for Heroin Detox
What Is Clonidine?
Clonidine, a centrally acting alpha-agonist hypotensive agent, is mainly used to treat high blood pressure by lowering heart rate and relaxing blood vessels. The extended-release form of the drug (Kapvay) may also be used with other medications to control the symptoms of attention-deficit hyperactivity disorder (ADHD).1
While these are the main uses for the drug, clonidine is also used off-label to treat severe menstrual cramps, Tourette’s syndrome, opioid and alcohol withdrawal, and nicotine addiction.1
How Is It Used in Detox?
Heroin withdrawal symptoms can be intense and severe, though they rarely pose life-threatening complications. However, the symptoms can become so uncomfortable that many people relapse without some form of medical assistance.
Under the supervision of a health care provider, clonidine can help manage common withdrawal symptoms such as:2
- Muscle aches.
- Runny nose.
However, clonidine does not reduce cravings or help with insomnia—which many users experience during withdrawal.2,3
An inpatient setting is recommended for clonidine detox—especially for heavy opioid users—because the staff and other patients can be sources of support, and health providers can monitor vital signs and side effects. Inpatient rehabs also reduce exposure to triggers a person would normally find in their regular environment. 3
Dosing and Tapering Schedule
Taken orally, the first dose is often 0.1 mg to 0.2 mg and then incrementally increased to a maximum of 1 mg a day, dependent on patient response. A dose of 0.2 mg may initially be given to people experiencing severe withdrawal. Once the dose is increased, the optimal dose is given for 2 to 4 days after the person stops using heroin or other opioids, when withdrawal symptoms are likely to be the most intense. Like most prescription medications, the dose is determined by your response to the drug and by evaluating your vitals such as pulse and blood pressure.3,4
The dose is then gradually reduced (tapered), and you can expect to stop taking clonidine around 7 to 10 days into detox.4
People with systolic blood pressure lower than 90 and diastolic blood pressure lower than 60 may not be treated with clonidine or may be taken off clonidine if their blood pressure drops below these thresholds during detox.3,4
Is Clonidine Right for Me?
Clonidine may be right for you if you:3,4,7
- Have a mild opioid addiction.
- Have high motivation for sobriety.
- Have some tolerance for withdrawal symptoms.
- Have a solid support system and social network.
- Do not have hypotension.
- Cannot take methadone or do not have access to it.
The physician or health care provider in your treatment program can evaluate you and determine whether clonidine is right for you based on your situation.
Pros vs. Cons
One of the advantages of clonidine is that it doesn’t produce a high. It is not addictive and does not have abuse potential. Most medical professionals can also prescribe clonidine, unlike buprenorphine (another medication for opioid addiction), which requires a special waiver. Methadone can only be prescribed in programs approved by the Substance Abuse and Mental Health Services Administration.3
On the flip side, clonidine cannot treat certain symptoms of withdrawal, such as insomnia, so it must be taken with other medications. Clonidine also does not treat cravings, which can be a major contributor to dropping out of treatment and relapsing.3 In addition, clonidine can cause side effects such as fatigue, headache, worry, lower sexual functioning, and stomach issues such as constipation. Severe side effects can include rash, difficulty breathing, hives, and face-swelling.1 Finally, some studies have found that completion rates for clonidine detoxification are low and depend on factors such as level of dependence and severity of withdrawal symptoms.3
Multiple studies have found that clonidine can help reduce withdrawal symptoms for people addicted to opioids. But they also highlight some of the drawbacks of the drug, such as its inability to treat certain symptoms and its side effects.
- A study of 1,728 people showed that clonidine was more successful than a placebo in managing withdrawal symptoms from heroin and methadone, and clonidine subjects had a greater chance of completing the treatment program. Compared to clonidine, methadone treatment lasted longer and had fewer side effects.5
- Ten men using clonidine to detox from a methadone maintenance program completed a self-report on their level of irritability and nervousness. Their reports showed a significant decrease in distress levels overall and indicated that they no longer needed to use methadone. They also showed a decrease in withdrawal symptoms after taking clonidine and did not experience any symptoms of withdrawal after a taper. However, the men did report difficulty falling asleep. At a 6-month follow-up, almost 50% of the men had returned to methadone maintenance or illicit drug use.6
- Studies on both people and animals have shown that clonidine significantly lowers the symptom severity of opioid withdrawal. Both outpatient and inpatient clinical studies have proven clonidine to be safe and effective in targeting many of opioid withdrawal symptoms.7
If you have decided to live an opioid-free life, detoxification is the initial step to recovery. However, it is not treatment for addiction. Substance abuse treatment, whether done in an inpatient or outpatient setting, occurs once you have rid your body of the substance and you’re ready to learn the skills necessary to navigate life without the use of drugs. Detoxification addresses the physiological recovery and treatment addresses the social and psychological components of drug abuse.
Without formal treatment, many people are likely to relapse when they return to their day-to-day lives and encounter the stressors, triggers, or personal issues that drove their addiction.
If you or someone you know is struggling with opioid addiction, there are detoxification and treatment programs available. Search our treatment directory for heroin detox and treatment centers that can help you in your recovery journey.
- U.S. National Library of Medicine. (2017). Clonidine.
- U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal.
- Substance Abuse and Mental Health Services Administration. (2013). Detoxification and substance abuse treatment.
- Elsevier, Inc. (2017). Opioid withdrawal.
- Gowing, L., Farrell, M., Ali, R., and White, J.M. (2016). Clonidine, lofexidine, and similar medications for the management of opioid withdrawal. Cochrane.
- Kleber, H.D., Gold, M.S., and Riordan, C.E. (1980). The use of clonidine in detoxification from opiates. United Nations Office on Drugs and Crime.
- Washton, A. and Resnick, R. (1981). Clonidine in opiate withdrawal: Review and appraisal of clinical findings. Pharmacotherapy, 1(2), 140-146.
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