A hypertensive man abruptly stops clonidine after running out of his tablets. Two days later he presents with severe headache, blood pressure 210/120 mmHg, palpitations, and sweating. The most appropriate initial management is:
- A IV sodium nitroprusside followed by taper over a week
- B Restart oral clonidine ✓
- C Oral captopril as monotherapy
- D Sublingual nifedipine and discharge home
Correct answer: B. Restart oral clonidine
Explanation
Clonidine withdrawal syndrome reflects supersensitivity of central alpha-2 receptors and overshoot catecholamine release after abrupt cessation. Reinstitution of clonidine promptly reverses the crisis and is the standard first step; if intravenous therapy is needed, labetalol or clonidine itself may be used, avoiding pure beta-blockade that leaves unopposed alpha tone. Sublingual nifedipine (option D) is obsolete for hypertensive emergencies due to unpredictable drops in pressure. Gradual tapering prevents recurrence.
Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
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