From the Guidelines
Clonidine is primarily used to treat hypertension, ADHD, anxiety disorders, opioid and alcohol withdrawal, and certain pain conditions, with a typical starting dose of 0.1 mg twice daily, which can be gradually increased to 0.2-0.6 mg daily in divided doses, with a maximum of 2.4 mg daily, as recommended by 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.
Uses of Clonidine
- Hypertension: Clonidine is used to treat high blood pressure, with a usual dose range of 0.1-0.8 mg/day in divided doses, as stated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
- ADHD: Clonidine is used to treat attention deficit hyperactivity disorder (ADHD) in children, with a recommended starting dose of 0.05 mg at bedtime, potentially increasing to 0.1-0.4 mg daily, as mentioned in the evidence-based pharmacological treatment options for ADHD in children and adolescents 1.
- Anxiety disorders: Clonidine is used to treat anxiety disorders, with a usual dose range of 0.1-0.6 mg daily in divided doses.
- Opioid and alcohol withdrawal: Clonidine is used to treat opioid and alcohol withdrawal, with a usual dose range of 0.1-0.3 mg every 6-8 hours, not exceeding 1.2 mg daily.
Dosages of Clonidine
- Oral tablets: 0.1-0.8 mg/day in divided doses, with a maximum of 2.4 mg daily.
- Transdermal patches: 0.1-0.3 mg/week, with a maximum of 0.6 mg/week.
Important Considerations
- Patients should avoid abrupt discontinuation of clonidine, as this can cause rebound hypertension, and the medication should be tapered to avoid this effect, as warned in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
- Blood pressure monitoring is essential when starting or adjusting doses of clonidine, particularly in elderly patients who may be more sensitive to its effects.
- Clonidine is generally reserved as a last-line treatment due to its significant CNS adverse effects, especially in older adults, as stated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults The dose of clonidine hydrochloride tablets, USP must be adjusted according to the patient’s individual blood pressure response. INDICATIONS AND USAGE Clonidine hydrochloride tablets, USP are indicated in the treatment of hypertension.
The uses of Clonidine include the treatment of hypertension. The dosages of Clonidine are as follows:
- Initial Dose: 0.1 mg tablet twice daily (morning and bedtime)
- Maintenance Dose: Further increments of 0.1 mg per day may be made at weekly intervals if necessary until the desired response is achieved
- Therapeutic Doses: 0.2 mg to 0.6 mg per day given in divided doses
- Maximum Effective Daily Dose: 2.4 mg per day 2 Clonidine may be employed alone or concomitantly with other antihypertensive agents 2
From the Research
Uses of Clonidine
- Clonidine is used as an antihypertensive agent to treat hypertension 3
- It is also used to treat attention-deficit hyperactivity disorder (ADHD) 4, 5
- Clonidine has been used in the treatment of autism spectrum disorder (ASD) comorbidity with ADHD 5
- It is used as an adjunct to opioids in palliative care for managing symptoms like cancer pain and agitation 6
- Clonidine can be used to treat hypertensive emergencies and urgencies 7
Dosages of Clonidine
- The initial oral dose of clonidine for hypertensive emergencies and urgencies is 0.1 to 0.2 mg, followed by hourly doses of 0.05 or 0.1 mg until goal blood pressure is attained 7
- The total dose should not exceed 0.7 mg 7
- For ADHD and ASD, the dosage of clonidine is not specified in the provided studies, but it is mentioned that clonidine is well tolerated and effective in improving symptoms 5
- For palliative care, the optimal dosing of clonidine requires further exploration through prospective research studies 6