Last update: March 17, 2019

C9 H9 Cl2 N3

High Risk for breastfeeding


Poorly safe. Evaluate carefully.
Use safer alternative or interrupt breastfeeding 3 to 7 T½.
Read the Comment.

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) or 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).

One-off use in a single dose (eg intrapartum) is very unlikely to cause problems for the newborn, so it can be considered compatible.

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.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

C9 H9 Cl2 N3 is Clonidine in Molecular formula.

Is written in other languages:

C9 H9 Cl2 N3 is also known as

Group

C9 H9 Cl2 N3 belongs to this group or family:

Tradenames

Main tradenames from several countries containing C9 H9 Cl2 N3 in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 65 -99 %
Molecular weight 230 daltons
Protein Binding 20 - 40 %
VD 2,1 l/Kg
pKa 8,3 -
Tmax 3 - 5 hours
T1/2 6 - 24 hours
M/P ratio 2 - 4 -
Theoretical Dose 0,0004 mg/Kg/d
Relative Dose 13,3 %
Relat.Ped.Dose 1,6 - 8 %

References

  1. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  2. Ornoy A. Pharmacological Treatment of Attention Deficit Hyperactivity Disorder During Pregnancy and Lactation. Pharm Res. 2018 Abstract
  3. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  4. Ball H, Blair PS. (For UNICEF UK). Caring for your baby at night. Health professional´s guide. 2017 Full text (link to original source) Full text (in our servers)
  5. BI - Boehringer Ingelheim. Clonidine. Drug Summary. 2016 Full text (in our servers)
  6. Sevrez C, Lavocat MP, Mounier G, Elefant E, Magnin S, Teyssier G, Patural H. [Transplacental or breast milk intoxication to clonidine: a case of neonatal hypotonia and drowsiness]. Arch Pediatr. 2014 Abstract
  7. UNICEF UK. Statement on co-sleeping following publication of new NICE postnatal guidance. Infosheet. 2014 Full text (link to original source) Full text (in our servers)
  8. UNICEF UK Baby Friendly Initiative statement on Bed-sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. 2013 Full text (link to original source) Full text (in our servers)
  9. BI - Boehringer Ingelheim. Clonidina. Ficha técnica. 2013 Full text (in our servers)
  10. L.Landa Rivera, M.Díaz-Gómez, A.Gómez Papi, J.M.Paricio Talayero, C.Pallás Alonso, M.T.Hernández Aguilar, J.Aguayo Maldonado, J.M.Arena Ansotegui, S.Ares Segura, A.Jiménez Moya, J.J.Lasarte Velillas, J.Martín Calama, M.D.Romero Escós. El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres. Rev Pediatr Aten Primaria. 14:53-60 2012 Full text (link to original source) Full text (in our servers)
  11. Ghanem FA, Movahed A. Use of antihypertensive drugs during pregnancy and lactation. Cardiovasc Ther. 2008 Abstract Full text (link to original source) Full text (in our servers)
  12. ABM - Comité de protocolos de la Academia médica de lactancia materna (Academy of Breastfeeding Medicine). Protocolo Clínico de la ABM #6: Lineamientos sobre la práctica de dormir al bebé junto con la madre y la lactancia materna Revisión, marzo de 2008. Breastfeeding Medicine 2008 Full text (link to original source) Full text (in our servers)
  13. ABM - The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding. Breastfeeding Medicine 2008 Abstract Full text (link to original source) Full text (in our servers)
  14. UNICEF UK. Compartiendo la cama con tu bebé. Guía para madres que amamantan. Folleto 2006 Full text (in our servers)
  15. Mendhekar DN. Clonidine-induced gynecomastia and hyperprolactinemia in a 6-year-old child. J Clin Psychiatry. 2005 Abstract
  16. Mokrani M, Duval F, Diep TS, Bailey PE, Macher JP. Multihormonal responses to clonidine in patients with affective and psychotic symptoms. Psychoneuroendocrinology. 2000 Abstract
  17. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  18. Bunjes R, Schaefer C, Holzinger D. Clonidine and breast-feeding. Clin Pharm. 1993 Abstract
  19. Boutroy MJ, Gisonna CR, Legagneur M. Clonidine: placental transfer and neonatal adaption. Early Hum Dev. 1988 Abstract
  20. Hartikainen-Sorri AL, Heikkinen JE, Koivisto M. Pharmacokinetics of clonidine during pregnancy and nursing. Obstet Gynecol. 1987 Abstract
  21. Heim J, Massart C, Auvray E, Allannic H. [Post-partum galactorrhea with hyperprolactinaemia persistent during a clonidine treatment (author's transl)]. Sem Hop. 1979 Abstract

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