Altered Mental Status Secondary to Clonidine Addiction and Withdrawal: A Cautionary Tale

Clonidine is a commonly prescribed medication with various indications that has abuse potential. This brief report outlines a case of clonidine misuse that led to clonidine withdrawal.

A 50-year-old male with a psychiatric history of Sedative-Hypnotic-Anxiolytic Use Disorder and Opioid Use Disorder in remission presented to the emergency department with a 1-day history of disorientation, slurred speech, word-finding difficulty, and altered mental status (AMS). Differential diagnoses included alcohol, benzodiazepine, and/or other substance intoxication versus withdrawal. The patient was placed on a lorazepam taper; however, his mental status worsened with further agitation, tachypnea, fever, tachycardia, hypertension, and myoclonus.

The patient was ultimately transferred to the intensive care unit, where he was placed on a dexmedetomidine infusion and steadily improved. Collateral information from the family revealed that the patient had been abusing clonidine. As the patient's mental status cleared, he too admitted to his clonidine addiction. During his admission, he was observed drinking large amounts of water and was also diagnosed with polygenic polydipsia. He was placed on fluid restriction, dexmedetomidine was eventually tapered, and he was ultimately discharged and referred to a dual diagnosis psychiatry unit for further treatment of his addiction.

This case demonstrates the importance of understanding the multiple etiologies of AMS, including drug intoxication and withdrawal, particularly with commonly prescribed medications. Clonidine has abuse potential, and clonidine withdrawal must be considered in the differential diagnosis of a patient with a hypertensive crisis and AMS.