Clonidine (off-label tobacco cessation / withdrawal context)
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-CLONIDINE-CESSATION |
|---|---|
| Тип | Препарат |
| Синоніми | CatapresCatapressanClonidine (tobacco cessation / withdrawal)Klofelinα2-agonist cessation — clonidineКлонідин (off-label — припинення куріння / абстиненція) |
| Статус | переглянуто 2026-05-18 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 |
Дані про препарат
| Клас | Centrally acting α2-adrenergic receptor agonist — off-label tobacco-cessation use |
|---|---|
| Механізм дії | Imidazoline derivative that selectively activates central α2- adrenergic receptors in the rostral ventrolateral medulla, decreasing sympathetic outflow (lowering blood pressure, heart rate, and CNS noradrenergic tone). Mechanism in tobacco cessation: nicotine withdrawal generates pronounced noradrenergic / sympathetic hyperactivity (anxiety, irritability, autonomic arousal); clonidine suppresses this withdrawal symptomatology, allowing better short-term abstinence rates. Cochrane meta-analyses (Gourlay 2004; superseded evidence base) reported approximate doubling of abstinence vs placebo (RR ~1.6-2.0), but with substantial discontinuation due to side effects (sedation, dry mouth, orthostatic hypotension) limiting practical utility. SECOND / THIRD-LINE option for cessation per USPSTF 2021 / AHCPR when first-line (varenicline, NRT, bupropion) have failed or contraindicated. Off-label use;... |
| Типове дозування | Tobacco cessation (off-label, AHCPR / Cochrane historical): PO: Start 0.1 mg BID; titrate to effect, typical target 0.15-0.4 mg/day in divided doses. Begin 1-3 days before target quit date. Total course typically 3-10 weeks. Tapered withdrawal mandatory to avoid rebound hypertension. Transdermal patch: 0.1 mg/24 h patch applied weekly (max 0.3 mg/24 h); onset slower (~2-3 days for therapeutic levels). Often better tolerated due to steadier levels. Elderly: start 0.05 mg BID. Renal impairment: reduce dose proportionally. |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | False |
| Остання перевірка для України | 2026-05-18 |
Нотатки
STUB — v0.2 prevention-workstream authoring (batch 3); pending two- Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode. OFF-LABEL tobacco- cessation agent — supported by historical Cochrane meta-analysis (Gourlay 2004) RR ~1.6-2.0 vs placebo for short-term abstinence, with significant discontinuation rates due to sedation, dry mouth, and orthostatic side effects. THIRD-LINE / SALVAGE position: USPSTF 2021 / AHCPR / Cochrane place varenicline (DRUG-VARENICLINE) first, then NRT + bupropion (DRUG-BUPROPION-SR), then nortriptyline (DRUG- NORTRIPTYLINE-CESSATION); clonidine is rarely used in current practice except in specific niches: (1) coexisting hypertension where the antihypertensive effect is desired, (2) patients with both tobacco use and opioid-use disorder where clonidine is also part of opioid- withdrawal management. KEY WARNINGS: mandatory taper on discontinuation to avoid rebound hypertension; avoid abrupt discontinuation especially if concurrent beta-blocker. Source cited (SRC-NCCN-BCELL-2025) is closest in-KB until USPSTF/AHCPR/Cochrane tobacco-cessation sources land in source-stub workstream.
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