Clonidine

Full Prescribing Information

DailyMed Drug Information

Forms/Strengths

Age: ≥ 6yr
Onset: 30-60 min (oral)
Duration: 6-12 hours
Considerations: Monitor for bradycardia and hypotension; taper gradually over 2-4 days (or longer based on dose/duration) to avoid rebound hypertension; often dosed BID with larger dose at bedtime for ADHD
Initial Dose:
- 27-40 kg: 0.05 mg nightly
- 40+ kg: 0.1 mg nightly
Titration:
- Increase 0.05mg every 3-7 d taper gradually over 2-4 days to discontinue
Max Dose:
- 27-40 kg: 0.2 mg/day
- 40+ kg: 0.4 mg/day

Central alpha-2 adrenergic agonist that reduces norepinephrine release and sympathetic outflow from the locus coeruleus.
Improves ADHD symptoms of hyperactivity, impulsivity, and inattention, especially as adjunct to stimulants.
Particularly useful off-label for ADHD with tics, aggression, or sleep issues.
Sedation common early and dose-dependent; often improves with time or bedtime dosing.
Low abuse potential; not a controlled substance.
Risk of rebound hypertension with abrupt discontinuation.
Not FDA-approved for ADHD (extended-release form Kapvay is approved).

ADHD (ICD-10: F90.0, F90.1, F90.2, F90.8, F90.9) – adjunct or monotherapy for hyperactivity/impulsivity.
Tic disorders/Tourette syndrome (ICD-10: F95.1, F95.2) – reduces tics via noradrenergic modulation.
Oppositional defiant disorder (ICD-10: F91.3) – decreases aggression when added to stimulants.
Insomnia/sleep disturbances in ADHD (ICD-10: G47.00) – promotes sleep with bedtime dosing.

Take at the same time each day for consistency.
Can be taken with or without food.
Swallow whole; do not crush or chew.
If used for ADHD, often given twice daily, with the larger dose at bedtime to minimize drowsiness.
Do not suddenly stop taking; tapering may be required to prevent rebound hypertension.
Transdermal patches should be applied to a hairless area on the upper outer arm or chest.

Common:
- Sedation/drowsiness (most prominent initially)
- Dry mouth
- Dizziness/orthostatic hypotension
- Constipation
- Fatigue/headache
Serious:
- Bradycardia/hypotension
- Rebound hypertension (with abrupt stop)
- Depression, hallucinations (rare)
- AV block (in cardiac disease)

When to Call the Doctor:
- Severe dizziness, fainting, or low blood pressure.
- Slow or irregular heart rate.
- Signs of over-sedation, such as excessive drowsiness or difficulty waking.
- Mood changes, hallucinations, or unusual behavior.
- Severe headache, blurred vision, or confusion (possible hypertensive rebound if stopped abruptly).
Safety Tips:
- Monitor blood pressure and heart rate regularly.
- Avoid alcohol and sedatives, which may enhance drowsiness.
- Rise slowly from sitting or lying positions to prevent dizziness.
- Do not suddenly discontinue, as this may lead to rebound hypertension.
- Be cautious when driving or operating machinery until individual response is known.
Parent Tips for Pediatric Patients:
- May cause daytime drowsiness; consider giving the larger dose at bedtime.
- Monitor for irritability, behavioral changes, or mood swings.
- Encourage hydration and salt intake if dizziness occurs.
- Ensure the child does not engage in high-risk activities (e.g., climbing, swimming unsupervised) if excessively drowsy.
- Keep in child-proof packaging to prevent accidental overdose.

Contraindications:
- Hypersensitivity to clonidine or formulation components.
- Use with caution in patients with severe heart disease, bradycardia, or hypotension.
Pregnancy:
- Category C; use only if benefits outweigh risks.
- May cause neonatal withdrawal symptoms.
Lactation:
- Excreted in breast milk; use with caution due to potential effects on infant blood pressure.
Drug Interactions:
- CNS depressants (e.g., alcohol, benzodiazepines) may increase sedation.
- Beta-blockers may enhance bradycardia; caution if discontinuing either drug.
- Stimulants (e.g., amphetamines) may counteract clonidine’s effects.
- Antihypertensive medications may lead to excessive blood pressure lowering.