What is the maximum dose of clonidine (antihypertensive medication)?

From the Guidelines

The maximum dose of clonidine is 0.8 mg per day, divided into two doses, for oral administration, as indicated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Considerations

• The dosing frequency for oral clonidine is twice daily, with a range of 0.1-0.8 mg per day 1.
• For transdermal patches, the maximum dose is 0.3 mg per day, with one patch applied weekly 1.
• Clonidine should be used with caution, especially in older adults, due to significant CNS adverse effects, and abrupt discontinuation should be avoided to prevent rebound hypertension 1.

Important Details

• Clonidine is a centrally-acting alpha-2 adrenergic agonist that reduces sympathetic outflow from the central nervous system, thereby decreasing blood pressure and heart rate 1.
• The guideline recommends clonidine as a last-line treatment option due to its significant CNS adverse effects, especially in older adults 1.
• Dosage adjustments may be necessary for patients with renal impairment, and lower doses are often recommended for elderly patients.

Clinical Implications

• Clinicians should carefully monitor patients for signs of hypotension, sedation, and dry mouth when initiating or titrating clonidine therapy 1.
• The maximum dose of clonidine should not be exceeded, and patients should be closely monitored for adverse effects, especially when using the oral or transdermal formulations 1.

From the FDA Drug Label

The therapeutic doses most commonly employed have ranged from 0.2 mg to 0.6 mg per day given in divided doses. Studies have indicated that 2. 4 mg is the maximum effective daily dose, but doses as high as this have rarely been employed. The maximum dose of clonidine is 2.4 mg per day.

• This dose is rarely employed, and most patients are maintained on lower doses, ranging from 0.2 mg to 0.6 mg per day. 2

From the Research

Maximum Dose of Clonidine

• The maximum dose of clonidine is not explicitly stated in the provided studies, but the dosages used in the studies can be referenced:
  • In the study 3, clonidine was titrated to achieve goal blood pressure in dosages of 0.05 mg twice daily to 0.2 mg three times daily.
  • In the study 3, some patients required doses of 0.1 mg to 0.3 mg twice daily to achieve blood pressure control.
• The studies do not provide a clear maximum dose, but rather a range of doses that were used to achieve therapeutic effects:
  • The study 4 discusses the efficacy of clonidine in treating hypertension, but does not specify a maximum dose.
  • The study 5 evaluates the efficacy and safety of clonidine extended-release and clonidine in children and adolescents with ADHD, but does not provide information on the maximum dose for hypertension.
  • The study 6 reports on the use of clonidine in the treatment of patients with hypertension over a period of 6 years, but does not specify a maximum dose.
  • The study 7 discusses the change from clonidine to beta blockers in hypertension, and mentions a dose of 0.3 mg t.i.d., but does not provide information on the maximum dose.