Clonidine

(clonidine)

Forms/Strengths

• Tablets: 0.1 mg, 0.2 mg, 0.3 mg

Dosing

• Age: ≥ 6yr
• Onset: 30-60 min (oral)
• Duration: 6-12 hours
• Considerations: Monitor for bradycardia and hypotension; taper off gradually to avoid rebound hypertension
• 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

Quick Facts

• Alpha-2 adrenergic agonist; reduces sympathetic outflow
• Decreases hyperactivity, impulsivity, and improves sleep in ADHD
• Off-label use for ADHD, especially in patients with comorbid tic disorders or poor stimulant response; often used as an adjunct to stimulants
• Common side effects: drowsiness, sedation, dry mouth, hypotension

Indications

•  ADHD (ICD-10: F90.0)

Off-Label Uses

• Tourette syndrome (ICD-10: F95.2)
• Oppositional defiant disorder: (ICD-10: F91.3)
• Sleep disturbances associated with ADHD (ICD-10: G47.00)

How to Take

• 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.

Side Effects

•  Common
  • Dry mouth
  • Drowsiness
  • Dizziness
  • Constipation
• Serious
  • Bradycardia
  • Hypotension
  • Withdrawal syndrome

Monitoring / Labs

• Blood pressure and heart rate monitoring
• Renal function tests

Education

• 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.

Additional Information

• 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.