Clonidine

(clonidine) 

 

 

 

 Full Prescribing Information 

 DailyMed Drug Information 

 

 

 

 

 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 

 

 Clonidine HCl Tablets Prescribing Information (DailyMed/FDA), 2023, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fe10c92-621a-4d36-b030-34098351a1e2 

 StatPearls: Clonidine, 2024, https://www.ncbi.nlm.nih.gov/books/NBK459124/ 

 Safety and Efficacy of Clonidine in Children with ADHD (PMC), 2014, https://pmc.ncbi.nlm.nih.gov/articles/PMC3926778/ 

 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