Careful monitoring of infusion pump function and inspection of catheter tubing for obstruction or dislodgement can help reduce the risk of inadvertent abrupt withdrawl of epidural clonidine. Patients should notify their physician immediately if clonidine administration is inadvertently interrupted for any reason. Patients should also be instructed not to discontinue therapy without consulting their physician. When discontinuing therapy with epidural clonidine, the physician should reduce the dose gradually over 2 to 4 days to avoid withdrawl symptoms. An excessive rise in blood pressure following discontinuation of epidural clonidine can be treated by administration of clonidine or by intravenous phentolamine.
Infections related to implantable epidural catheters pose a serious risk.
Evaluation of fever in a patient receiving epidural clonidine should include the possibility of catheter-related infection such as meningitis or epidural abscess. In patients who have developed localized contact sensitization to clonidine film, substitution of oral clonidine hydrochloride therapy may be associated with the development of a generalized skin rash. As with all antihypertensive therapy , clonidine hydrochloride should be used with caution in patients with severe coronary insufficiency, recent myocardial infarction, cerebrovascular disease or chronic renal failure. Patients should be instructed not to discontinue therapy without consulting their physician. Rare instances of hypertensive encephalopathy and death have been reported.