In this episode, I’ll discuss why beta-blockers should be tapered before clonidine.
For patients taking concomitant beta-blocker and clonidine therapy who require tapering, the recommendation is to taper the beta-blocker first, followed by the clonidine. The concern if this taper order is not followed is the development of severe hypertension.
This reason for this recommendation is to avoid potential “unopposed alpha agonism” that may occur if the clonidine is stopped first. This is similar to the warning against using a beta-blocker in a patient on cocaine. The beta-blocker is withdrawn first so that beta-2 effects are not blocked and can therefore balance the effects of clonidine withdrawal when the clonidine is tapered.
The risk of severe hypertension from this interaction may be less significant with cardioselective beta-blockers, or labetalol with its combined alpha and beta blocking effects..
Shout out to “Pharmacy Luna” who inspired this episode!
Members of my Hospital Pharmacy Academy have access to practical training on how to taper medications including opioids, benzos, cardiovascular medications, steroids, and others. This is in addition to over 100 trainings and resources to make your practice easier. To get immediate access go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
https://litfl.com/beta-blockers-for-cocaine-and-other-stimulant-toxicity/
The dogma is outdated, please do not perpetuate it.