Kapvay

(Clonidine hydrochloride)

Forms/Strengths

• Tablets: 0.1 mg, 0.2 mg, 0.3 mg

Dosing

• Age: ≥ 6 y/o
• Onset: 
• Duration: 12-24 hours
• Considerations: Monitor for hypotension, bradycardia, and sedation. Titrate slowly.
• Initial Dose: 0.1 mg orally once daily at bedtime
• Titration: Increase by 0.1 mg weekly
• Max Dose: 0.4 mg once daily

Quick Facts

• Selective alpha-2 adrenergic receptor agonist; reduces sympathetic outflow
• Improves prefrontal cortex regulation; decreases hyperactivity and impulsivity
• Extended-release formulation for adjunctive ADHD management; may improve sleep
• Less effective for inattention compared to stimulants
• Common side effects: drowsiness, sedation, dry mouth, hypotension

Indications

•  ADHD (ICD-10: F90.0)

Off-Label Uses

How to Take

• Take twice daily, with doses about 12 hours apart.
• Swallow the tablet whole; do not crush, chew, or split.
• Can be taken with or without food, but be consistent with food intake for stable absorption.
• If a dose is missed, take it as soon as possible unless it is close to the next dose—do not double up.
• Do not abruptly stop taking; tapering may be required to prevent rebound hypertension.

Side Effects

• Common: Somnolence, fatigue, headache, abdominal pain, increased heart rate, nasal congestion, irritability, throat pain, rash.
• Serious: Hypotension, bradycardia, cardiac conduction abnormalities.

Monitoring / Labs

• Monitor heart rate and blood pressure prior to initiation, following dose increases, and periodically during therapy.

Education

• When to Call the Doctor:

  • Severe dizziness, fainting, or low blood pressure.
  • Slow or irregular heart rate.
  • Excessive drowsiness or difficulty waking.
  • Mood changes, depression, 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.
  • Use caution when driving or operating heavy machinery due to possible sedation.
  • Taper gradually when discontinuing to avoid withdrawal symptoms.

• Parent Tips for Pediatric Patients:

  • May cause daytime drowsiness; consider giving the larger dose at bedtime if drowsiness is problematic.
  • Monitor for irritability, mood swings, or behavioral changes.
  • Encourage hydration and balanced nutrition to minimize side effects.
  • Ensure children do not engage in high-risk activities (e.g., swimming, biking) if excessively drowsy.
  • Store 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 when using together.
  • Stimulants (e.g., amphetamines) may counteract Kapvay’s effects.
  • Antihypertensive medications may lead to excessive blood pressure lowering.