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Clonidine
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Clonidine can be used to reduce autonomic hyperactivity in opioid withdrawal. The dose is 25-150mcg three times daily, adjusted according to response for up to 3 days. Then reduce by a quarter of third day's dose over the next 3 days and as withdrawal symptoms subside. Withhold dose if blood pressure is below 100/60 or heart rate below 60.
Skin irritation is common with clonidine patches. The risk can be reduced by avoiding hard soaps, applying a lipid-rich moisturiser several hours before applying the patch, gently cleaning the residual adhesive after removing the patch, and rotating the site. If persistent then trial steroid ointment before applying the patch.
