Clonidine Hydrochloride

A centrally-acting antihypertensive and antiadrenergic with hypotensive effect. It has sedative and anxiolytic effects and potentiates the effect of morphine and various anesthetics. Indicated in the treatment of hypertension, migraine and, in topical use (eye drops), of glaucoma. Off-label, it is used in the treatment of opioid dependence, as a diagnostic test for pheochromocytoma, in pre-anesthesia and as an adjuvant in epidural anesthesia. Oral administration twice a day.

It is excreted in breastmilk in small quantities ^{(Bunjes 1993, Hartikainen 1987)}, but it could be significant as it implies a relative dose of close to 10%.

In several cases there were no short-term or long-term problems in infants whose mothers were taking it ^{(Bunjes 1993, Hartikainen 1987)}, no detectable levels of clonidine in infant plasma. ^{(Bunjes 1993)}

A newborn presented hypotonia, drowsiness and apneas during the first 10 days of life until breastfeeding was stopped, although he was already exposed to clonidine during pregnancy via the placenta ^{(Sevrez 2014)}, so, perhaps in these cases, it would be advisable to suspend treatment, changing it to one which is more compatible, 4 to 5 days before birth.

Clonidine may increase the secretion of prolactin ^{(Mendhekar 2005, Mokrani 2000)} and produce gynecomastia (Mendhekar 2005) or galactorrhea. ^{(Heim 1979)}

Because it can cause sedation and drowsiness, it is not advisable to share a bed with the baby if this medication is taken. ^{(UNICEF 2013, Landa 2012, ABM 2008, UNICEF 2006)}

Punctual single neuraxial dose use (e.g. intrapartum or immediate postpartum) may decrease the use of systemic opioids and is very unlikely to cause problems for the newborn, so it can be considered compatible. ^{(Martin 2018)}

TOPICAL (OPHTALMOLOGIC) USE:

The small dose and poor plasma absorption of most topical ophthalmic preparations make it unlikely that significant amounts will transfer into breastmilk. Topical use in the form of eye drops is compatible with breastfeeding. In ophthalmic administration, absorption can be minimized by pressing a finger on the tear duct (medial canthus of the eye) for 1 minute.