What is the starting dose and titration for Clonidine (Catapres)?

Clonidine (Catapres) Starting Dose and Titration Guidelines

The recommended starting dose for Clonidine (Catapres) is 0.1 mg twice daily (morning and bedtime), with gradual titration by 0.1 mg per day at weekly intervals until desired response is achieved, not exceeding a maximum daily dose of 0.4 mg. 1

Initial Dosing

• Standard starting dose: 0.1 mg twice daily (morning and bedtime)
• For elderly patients: Consider a lower initial dose (0.05-0.1 mg)
• Taking the larger portion of the daily dose at bedtime helps minimize side effects like dry mouth and drowsiness

Titration Schedule

• Increase by 0.1 mg per day at weekly intervals as needed
• For ADHD treatment specifically:
  • Start with 0.05-0.1 mg at bedtime
  • Increase by 0.1 mg BID-TID to a maximum of 0.4 mg per day 2

Dosing by Indication

1. Hypertension:

   • Therapeutic doses typically range from 0.2 mg to 0.6 mg daily in divided doses
   • Maximum effective daily dose: 2.4 mg (rarely used) 1

2. ADHD:

   • Starting dose: 0.05-0.1 mg at bedtime
   • Titration: Increase by 0.1 mg BID-TID
   • Maximum dose: 0.4 mg daily 2

3. PTSD-associated nightmares:

   • Start at 1 mg at bedtime
   • Increase by 1-2 mg every few days until effective
   • Average effective dose: approximately 3 mg
   • Range: 1-10+ mg has been found effective 2

Special Populations

• Renal impairment: Lower initial dose; careful monitoring required
• Hemodialysis: No dose adjustment needed as minimal clonidine is removed during dialysis 1

Administration Considerations

• Pharmacokinetics:

  • Onset of action: 30-60 minutes after oral administration
  • Peak effect: 2-4 hours
  • Duration of action: 6-8 hours
  • Half-life: 12-16 hours 3

• Safety monitoring:

  • Check blood pressure before each dose
  • Document response 1-2 hours after administration
  • Withhold dose if systolic BP <90 mmHg or heart rate <60 bpm 3

Important Precautions

• Never abruptly discontinue clonidine (risk of rebound hypertension)
• Avoid gaps of >24 hours between doses if used regularly
• Monitor for orthostatic hypotension, especially with higher doses 3
• Common side effects: sedation, dry mouth, dizziness

Breastfeeding Considerations

• Limited data on safety during breastfeeding
• Clonidine is found in human milk and detectable in infant serum
• M:P ratio reported as 2 with a RID up to 7.1%
• Monitor breastfed infants for drowsiness, hypotonia, and potential adverse effects 2

While some research suggests higher loading doses (0.2 mg initially followed by 0.1 mg hourly) for hypertensive emergencies 4, 5, 6, the standard starting dose of 0.1 mg twice daily with weekly titration remains the recommended approach for most patients requiring clonidine therapy.