MajorCentral α2-adrenergic agonist×Selective β1-adrenoceptor blockers
Updated · Methodology
Mechanism
Abrupt clonidine withdrawal on a beta-blocker triggers a hypertensive crisis: the α2 effect is lost while β-blockade persists – an 'unopposed' α1 effect develops with a sharp blood pressure rise. Additional additive bradycardia.
Symptoms
Abrupt clonidine withdrawal causes hypertensive crisis: sharp blood pressure rise, headache, tachycardia, anxiety, sweating. Symptoms appear 18–24 hours after a missed clonidine dose.
Management
For planned clonidine withdrawal, stop metoprolol 3–7 days beforehand, then taper clonidine over 1–2 weeks. Alternative antihypertensives: an ACE-I (enalapril) plus amlodipine without clonidine.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
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Sources
- FDA: Clonidine hydrochloride tablet (Alembic Pharmaceuticals Limited) – Prescribing Information section 7 (2012)– ; DailyMed setid 88a8db46-0fc9-48cd-b7cc-ac9c9cdea100
- AEMPS: Ficha técnica: Metoprolol 100 mg (Aurovitas) (nº registro 82000), sección 4.5 (2026)– AEMPS, CIMA, nº registro 82000, revisión 04/2026, sección 4.5