# Clonidine ### (clonidine)
**[Full Prescribing Information](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=a842ab83-3531-44dd-a8a8-64dd89e87026&type=display)**[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a842ab83-3531-44dd-a8a8-64dd89e87026)
--- **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 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 --- ### **Quick Facts** - **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). --- ### **Indications** - **Hypertension** (ICD-10: I10, I11.0, I11.9) --- ### **Off-Label Uses** - **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. --- ### **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:** - 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) --- ### **Monitoring / Labs** - Baseline and periodic blood pressure and heart rate (supine and standing). - ECG if history of cardiac disease. - Renal function (dose adjust in impairment). - Growth parameters in children (long-term use). --- ### **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. ### **References** 1. Clonidine HCl Tablets Prescribing Information (DailyMed/FDA), 2023, [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fe10c92-621a-4d36-b030-34098351a1e2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fe10c92-621a-4d36-b030-34098351a1e2) 2. StatPearls: Clonidine, 2024, [https://www.ncbi.nlm.nih.gov/books/NBK459124/](https://www.ncbi.nlm.nih.gov/books/NBK459124/) 3. Safety and Efficacy of Clonidine in Children with ADHD (PMC), 2014, [https://pmc.ncbi.nlm.nih.gov/articles/PMC3926778/](https://pmc.ncbi.nlm.nih.gov/articles/PMC3926778/) 4. AACAP Practice Parameters for ADHD (via UpToDate integration), 2022, [https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-treatment-with-nonstimulant-medications](https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-treatment-with-nonstimulant-medications)