Regimen for the control of blood pressure and symptoms during clonidine withdrawal

Abrupt withdrawal of the centrally-acting antihypertensive agent, clonidine, is associated with a high incidence of rebound hypertension and tachycardia, with symptoms of sympathetic overactivity and increased catecholamine excretion. Gradual clonidine withdrawal has been recommended, but does not always avoid the reaction. A regimen is described comprising high doses of the alpha 1-adrenoceptor antagonist, prazosin, the cardioselective beta-blocker, atenolol, and chlordiazepoxide, specifically designed to counter both central and peripheral effects of sudden withdrawal of a central alpha 2-adrenoceptor agonist. This combination was completely successful in preventing the haemodynamic and symptomatic features of clonidine withdrawal in eight hypertensive patients.