A 54-year-old man ran out of his tablets three days ago and presents with blood pressure of 224/126 mmHg, sweating, tremulousness, palpitations and throbbing headache. His medication list shows he had been taking clonidine 0.3 mg twice daily. What is the best immediate management?
- A Resume oral clonidine and observe ✓
- B Intravenous propranolol bolus
- C Intravenous furosemide
- D Oral amlodipine and discharge home
Correct answer: A. Resume oral clonidine and observe
Explanation
Abrupt clonidine withdrawal causes rebound sympathetic overactivity with hypertension, tachycardia, sweating and tremor, because presynaptic alpha-2 inhibition of norepinephrine release is suddenly lost. The definitive treatment is simply restarting clonidine, orally or by transdermal patch, which resolves the crisis rapidly. Beta blockers given alone can worsen the unopposed alpha vasoconstriction, diuretics do not address the mechanism, and starting amlodipine leaves the underlying catecholamine excess untreated.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.