Clonidine Plus Beta Blocker Synergism?

[peregrine]

Managed to persuade my neurologist to try clonidine - taking 0.1mg twice daily. I also take 25mg of atenolol. It's been a week at this point.

The clonidine has so far been pretty awesome - I just *feel* better, it's hard to describe. If something startles me, I go "eek!" but I don't get an adrenaline rush afterwards, which is wonderful. I get home and I can cook dinner and even wash the dishes on weekends - again, awesome. The spaciness does seem to be somewhat lessened; I also discovered that - shockingly - things look like they move towards you when you walk forward! Amazing :^) Apparently I'd totally failed to notice that the spaciness came with losing track of three-dimensional motion. In general I'm just calmer, and not as tired. I wonder if the spaciness is related to sympathetic overactivity, given that the clonidine is helping?

It has downsides, though. I've got some muscle weakness - mostly just individual muscles either walking or holding/typing things - which is intermittant and not too severe. The big issues are blood pressure effects and sleepiness. Not fatigue per se - just sleepiness. I fall asleep sitting up at my desk, and almost fall asleep talking with someone one on one or doing other things that require me to be alert. Obviously not driving! It's weird, though - as long as I'm on my feet or moving around I'm better, it's just sleepiness when I'm sitting down. Unfortunately this combines with the low blood pressure to make me more spacey, just spacey in a different way - "sleepy plus lightheaded" spacey instead of "usual" spacey.

The blood pressure thing is funny. I normally range from "normal" BP (~110/70) to borderline hypertensive (140/85), but my TTT was all over the charts (62/50 to 170/100 and rapidly switching). With the clonidine plus atenolol, my BP was at 85/45 for a good part of the first day, which led to me almost going down with no warning at work. Standing up more slowly and avoiding picking things up off of the floor or bending over has helped some.

I know beta blockers are supposed to lower your BP (although at 25mg of atenolol it should be minor-ish). I didn't take my atenolol one day (from what I know, the danger is in stopping clonidine while on a beta, not vice versa), and although my heart rate was a bit more labile and I had palpitations, the blood pressure and lightheadedness were a bit better. A half-dose of atenolol was a bit better, although I was more lightheaded again. I'll ask my neuro on Monday about it.

Does anyone have any insight in terms of things to deal with the sleepiness? The Ritalin hasn't helped much. The blood pressure/heart rate tradeoff with the clonidine/beta blocker is also weird. I'm not sure how trivial it is to take smaller doses of clonidine - obviously something to run by the neurologist - but insights would be appreciated (I know that issie took lower doses of clonidine in the past). Do things like the sleepiness and lightheadedness go away at some point (or become less bad), and are they less bad with the patch instead of the twice-daily pill? Thanks!

(edit - could the additive/synergistic/whatever effects of the clonidine and the atenolol affect the sleepiness as well? I'm completely unsure. I've also had dry mouth and mild constipation on the clonidine, but nothing severe)

(double edit - gah, you can tell how with it I am today! - I hadn't worn my compression stockings for two months after my legs got pretty strong. I noticed myself pooling visibly, which almost never happens, after taking albuterol last week pre-clonidine, so I started wearing them, and am still taking my salt, both of which should be helping my BP)

[corina]

Can't really help with your questions Peregrine, just wanted to let you know that I'm happy the clonidine is helping you!!!

[peregrine]

Thanks! We're going to try a lower dose - 0.05mg twice daily - and see what happens. Still going to take the beta blocker too.