Assess cardiovascular status, mental-health history, and concurrent medications before starting clonidine; beta-agonist reversal of hypotension can be difficult once toxicity occurs.
Absolute contraindications include prior anaphylaxis to clonidine or adhesive components of the transdermal system, and use in neonates with significant sinus node dysfunction. Relative contraindications cover bradyarrhythmias, hypotension, severe coronary artery disease, depressive disorders, and advanced renal insufficiency where drug clearance is prolonged.
Known hypersensitivity to clonidine or formulation excipients
Use of clonidine transdermal system in patients with adhesive sensitivity or contact dermatitis
Sinus node dysfunction, AV block, or bradyarrhythmias without a pacemaker
Symptomatic hypotension or autonomic dysfunction—risk of profound blood pressure drops
Major depressive disorder or history of suicidal ideation—monitor mood closely
Renal impairment (creatinine clearance <30 mL/min) or hepatic impairment—titrate slowly and monitor for accumulation
Concomitant CNS depressants, antihypertensives, or beta-blockers—additive sedation and hypotension
Abrupt withdrawal risk—ensure caregivers understand tapering requirements