Hi everybody. I came across this recently and figured it deserved a posting. Anybody tried?

Bottom Line: In a well controlled study, topical clonidine gel significantly reduces the level of foot pain in painful diabetic neuropathy subjects. The treatment with clonidine was safe and without the problematic side effects typically associated with systemic therapies.

I would recommend that people with Type II diabetes who are experiencing severe pain in their feet talk with their doctors about this.

Study Citation & Abstract:

Campbell CM, Kipnes MS, Stouch BC, Brady KL, Kelly M, Schmidt WK, Petersen KL, Rowbotham MC, Campbell JN. (2012). Randomized control trial of topical clonidine for treatment of painful diabetic neuropathy. Pain. 2012 Sep;153(9):1815-23.

Abstract
A length-dependent neuropathy with pain in the feet is a common complication of diabetes (painful diabetic neuropathy). It was hypothesized that pain may arise from sensitized-hyperactive cutaneous nociceptors, and that this abnormal signaling may be reduced by topical administration of the α(2)-adrenergic agonist, clonidine, to the painful area. This was a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. Nociceptor function was measured by determining the painfulness of 0.1% topical capsaicin applied to the pretibial area of each subject for 30minutes during screening. Subjects were then randomized to receive 0.1% topical clonidine gel (n=89) or placebo gel (n=90) applied 3 times a day to their feet for 12weeks. The difference in foot pain at week 12 in relation to baseline, rated on a 0-10 numerical pain rating scale (NPRS), was compared between groups. Baseline NPRS was imputed for missing data for subjects who terminated the study early. The subjects treated with clonidine showed a trend toward decreased foot pain compared to the placebo-treated group (the primary endpoint; P=0.07). In subjects who felt any level of pain to capsaicin, clonidine was superior to placebo (P<0.05). In subjects with a capsaicin pain rating ⩾2 (0-10, NPRS), the mean decrease in foot pain was 2.6 for active compared to 1.4 for placebo (P=0.01). Topical clonidine gel significantly reduces the level of foot pain in painful diabetic neuropathy subjects with functional (and possibly sensitized) nociceptors in the affected skin as revealed by testing with topical capsaicin. Screening for cutaneous nociceptor function may help distinguish candidates for topical therapy for neuropathic pain.

Here is to Peace, Love, and Understanding,

Mike

Some of the compounded creams with several drug ingredients include clonidine.

The transdermal versions of this will deliver clonidine into the blood as well, and therefore it may affect blood pressure.

Clonidine has been used for many years in RSD patients whose neuropathy is slightly different from PNers. There are patch formulations that have been tried in RSD patients in the past.

I don't see clonidine mentioned as often on RSD today, but some of them may still have this ingredient in their compounded various transdermal creams.

The article is interesting though, but supervision and close attention to systemic clonidine actions must be maintained. Clonidine is not often used for blood pressure today as in the "olden" days...basically because of compliance risks. If it is discontinued suddenly there can be a huge blood pressure rise/spike, as a withdrawal event. This can be dangerous in some people (burst a hidden aneurysm or cause a stroke).

For example, the clonidine patch on the market today delivers .1mg of drug transdermally per day. That is a very small amount.

.1% as in the article would deliver, that same amount or more depending on area covered/amount used per dose. I suspect "more" would be the rule. It would be dicey to use this therapeutically....this article only mentions "diagnostic tool" use.

Time will tell if this progresses to clinical applications long term.

Thanks for posting it, however.

Yes, I first came across this article as I was doing background reading for a compounding cream that I am using. The cream that I am using includes Clonodine and has quite a drug store of compounds:

Flurbiprophen Powder - an NSAID, an anti-inflammatory,
Bupivacaine Powder - a local anasthetic, (with cardiotoxic risks),
Psyclobenzaprine HCL - a muscle relaxant (fexaril) (and off-label treatment for fibromyalgia),
Tramadol HCL Powder - an opiate working on the mu transmitter,
Clonidine HCL Powder - see below, and
PCCA Custom Lipo-max Cream - the base into which the compounds are mixed.

Clonidine HCL Powder - is an approved treatment for ADHD and High Blood Pressure and used off-label quite a bit. According to wikipedia, it is a sympatholytic medication used to treat high blood pressure, ADHD, anxiety/panic disorder, and certain pain conditions. It is used to treat torrette syndrome (tics), stress, sleep disorders, anxiety, borderline personality disorder, PTSD, migraine headaches, hot flashes associate with menopause, and facial flushing and redness associated with rosacea. It is used as an epidural for severe pain. And, as in my off-label compound, It has also been successfully used topically in a clinical trial as a treatment for diabetic neuropathy.

For those who may not be aware of compounding, "Pharmacy compounding is the art and science of preparing personalized medications for patients. Compounded medications are “made from scratch” – individual ingredients are mixed together in the exact strength and dosage form required by the patient. This method allows the compounding pharmacist to work with the patient and the prescriber to customize a medication to meet the patient’s specific needs." (Taken from the PCCA website. PCCA is something like the Professional Compounding Association.)

I got involved through my pain management physician who enrolled me into a clinical trial,

P,L,U,

Mike

One thing you miss by only reading.... is that the actual clinical use does not always match what you read.

Clonidine is not easy to tolerate, so it is not used as much as you would think. My son took .05mg daily with his Ritalin...it really was hard on him! That treatment didn't last long. I discovered that Omega-3 supplements completely removed his need for ADHD drugs.

Clonidine is also not used much anymore for hypertension. It has a nasty side effect of causing mania and insomnia in some people.
It is also seriously dangerous in hypertensive people who may run out of medication or skip doses. For a while it was also used as an adjunct for addiction to drugs. Cocaine especially. So popular on the street at one time we'd get forgeries for it.

Flexeril works mainly centrally in the brain ...so I don't know how effective it would be topically transdermally.

But many of the topical compounded creams do work.

You should try the new Morton Epsom Lotion! It is fantastic on the feet, or cramping areas, or swelling. Available at WalMart, Walgreen's and online at Amazon. Many people on the NT forums are using it successfully now including me.

Some of the transdermal compounded creams have magnesium added. This you can do yourself.

http://www.amazon.com/Morton-Epsom-L.../dp/B008X365AU

Magnesium is a NMDA pain receptor antagonist and will reduce nerve pain. It relaxes muscle tension and improves circulation to the small vessels in the feet and lower legs and hands.

I was given a compounded cream with Clonidine in it. I am using it since December. I am not diabetic (but i have some problems with spikes). The compounded cream works for me, though not consistently and not completely But having been in pain for over 2 years, relief on some days is very much welcome.

But of course, it may be a combination of everything....gabapentin, supplements, magnesium lotion and recently the compounded cream. Whatever it is, i am definitely grateful for this some semblance of tolerable pain.

The Clonidine % is very low but i am wondering if this will affect my BP. Prior to starting the compounded cream, I was experiencing episodes of dizziness and when i checked my BP it was low. I still have the episodes on and off now that i am on the cream, well, i just hope it does not contribute to this low BP.