# Novel Use of Clonidine Patch to Treat Tizanidine Withdrawal

## TL;DR

A patient experienced severe symptoms after stopping tizanidine, and using a clonidine patch helped manage the withdrawal.

## Contribution

The paper introduces the novel use of a clonidine patch as a treatment for tizanidine withdrawal.

## Key findings

- A patient showed withdrawal symptoms after stopping tizanidine, including high blood pressure and agitation.
- Oral clonidine helped manage the withdrawal, but symptoms recurred later.
- Using a clonidine patch taper may be a better approach for tizanidine withdrawal.

## Abstract

Tizanidine is commonly prescribed for muscle spasticity and pain. Yet, withdrawal is rarely reported. Tizanidine stimulates presynaptic α-2 adrenergic and imidazoline receptors decreasing norepinephrine release. Abrupt cessation can cause withdrawal. Current treatment strategies include tapering oral tizanidine or substituting oral clonidine. A 52-year-old male with a history of hypertension, diabetes, coronary artery disease, and chronic back pain presented with altered mental status, agitation, hypertensive emergency (blood pressure: 250/145 mmHg), and tachycardia. The patient had been prescribed tizanidine for chronic back pain for two years and had recently run out with suspicion of misuse. Tizanidine withdrawal was diagnosed, and he improved with 0.1 mg oral clonidine three times daily weaned over five days while hospitalized. One month later the patient was admitted for persistent hypertension, tachycardia, diaphoresis, and anxiety. Alpha-2 agonist withdrawal was again diagnosed. Utilizing a clonidine patch taper may offer a reasonable approach in patients with tizanidine withdrawal.