No, clonidine should NOT be given 20 mg three times a day
This dose is dangerously high and far exceeds the maximum recommended daily dose of clonidine, which is 0.4 mg/day for most indications and up to 2.4 mg/day maximum in rare cases.
Critical Dosing Information
The FDA-approved dosing for clonidine is 1:
- Starting dose: 0.1 mg twice daily (morning and bedtime)
- Maintenance dose: 0.2-0.6 mg/day in divided doses
- Maximum effective dose: 2.4 mg/day (rarely employed)
- Doses higher than 0.4 mg/day are not recommended for standard use 2
A dose of 20 mg three times daily (60 mg/day total) represents a 25-fold to 300-fold overdose compared to typical therapeutic ranges.
Appropriate Dosing Regimens
For Hypertension (Adults):
- Begin with 0.1 mg twice daily
- Increase by 0.1 mg/day at weekly intervals if needed
- Most patients respond to 0.2-0.6 mg/day in divided doses 1
- Three times daily dosing (0.1-0.2 mg TID) provides better blood pressure control than once or twice daily, but the total daily dose remains 0.3-0.6 mg 3, 4
For ADHD (Pediatric):
- Starting dose: 0.1 mg at bedtime
- Can increase to twice-daily administration
- Maximum: 0.4 mg/day 2
For Critical Care/Sedation:
- Low-dose: ≤0.4 mg/day
- High-dose: >0.4 mg/day (up to approximately 0.8-1.2 mg/day in select ICU patients)
- Even in critically ill adults, doses >0.4 mg/day are considered "high-dose" 5
Serious Safety Concerns
Clonidine at excessive doses causes:
- Severe hypotension and bradycardia 2
- Profound sedation and syncope 2
- Cardiac conduction abnormalities 2
- Risk of rebound hypertension with abrupt discontinuation 1
Common Pitfall
The question likely contains a transcription or unit error. The intended dose may have been:
- 0.2 mg (not 20 mg) three times daily, which would total 0.6 mg/day—a reasonable maintenance dose
- Or confusion between clonidine and another medication entirely
Always verify unusual doses before administration, as this represents a potentially fatal medication error.