Aspects of Clonidine Therapy

To the Editor: In his recent review (N Engl J Med 293:1179-1180, 1975) Dr. Pettinger discusses treatment of the clonidine withdrawal syndrome with propranolol. This approach controls the symptoms rapidly but does not control the hypertension,1which is the most important aspect of the syndrome. Hansson1gave his patients propranolol first, and then intravenous phentolamine, but did not try the effect of phentolamine alone in suppressing the symptoms. There are dangers in using propranolol in conditions where there are high circulating catecholamine levels. By blocking the peripheral beta-vasodilating effects of epinephrine any alpha effect will be potentiated, possibly making. . . © 1976, Massachusetts Medical Society. All rights reserved.