Clonidine Patch Dosing for Hypertension and ADHD
For hypertension, the clonidine patch is dosed at 0.1-0.3 mg applied once weekly, while for ADHD, the recommended dosing is not clearly established for the patch formulation, though oral clonidine is typically started at 0.1 mg at bedtime and titrated up to a maximum of 0.4 mg/day. 1, 2
Clonidine Patch for Hypertension
Dosing Guidelines
- Starting dose: 0.1 mg patch applied once weekly to a hairless area of intact skin on the upper outer arm or chest 1, 3
- Titration: If blood pressure reduction is not achieved after 1-2 weeks, increase dosage by:
- Adding another 0.1 mg patch, or
- Changing to a larger system (0.2 mg or 0.3 mg) 3
- Maximum dose: Doses above two 0.3 mg patches are usually not associated with additional efficacy 3
- Application site: Each new application should be on a different skin site from the previous location 3
Important Considerations
- Clonidine patches are generally reserved as a last-line therapy for hypertension due to significant CNS adverse effects, especially in older adults 1
- Onset of antihypertensive effect may not begin until 2-3 days after initial application 3
- When switching from oral clonidine or other antihypertensive medications, gradual reduction of prior drug dosage is advised 3
Clonidine for ADHD
Oral Clonidine Dosing (Extended Release)
- Starting dose: 0.1 mg tablet at bedtime 2
- Titration: Can increase to twice-daily administration with careful uptitration 2
- Maximum dose: 0.4 mg/day 2
Patch Formulation for ADHD
While specific patch dosing guidelines for ADHD are not as clearly established as for oral formulations, the same principles of starting low (0.1 mg patch weekly) and titrating based on response and tolerability would apply.
Safety Considerations and Monitoring
Common Side Effects
- Somnolence/sedation
- Fatigue
- Irritability
- Insomnia and nightmares
- Dry mouth
- Bradycardia
- Hypotension 2
Warnings and Precautions
- Abrupt discontinuation: Avoid sudden discontinuation as this may induce hypertensive crisis; clonidine must be tapered to avoid rebound hypertension 1
- Skin reactions: About 23% of patients may experience skin reactions with the patch formulation 4
- Cardiovascular effects: Monitor for hypotension, bradycardia, and cardiac conduction abnormalities 2
Special Populations
- Renal impairment: Dosage must be adjusted according to the degree of impairment 3
- Pregnancy: Limited data suggests clonidine is likely not associated with adverse pregnancy outcomes, but should be used with caution 2
- Breastfeeding: Clonidine is found in human milk; monitor breastfed infants for drowsiness and hypotonia 2
Clinical Efficacy
- For hypertension, clonidine patches provide smooth, predictable blood pressure reduction 4
- For ADHD, symptomatic improvement typically begins after 2 weeks of treatment, with an effect size generally in the medium range, smaller than stimulants 2
Comparative Considerations
- Compared to guanfacine, clonidine is approximately ten times more potent, has less specificity for alpha-2A receptors, and may have more sedative effects 2
- Clonidine is generally considered a second-line treatment for ADHD after stimulants due to smaller effect size 2
Remember that the transdermal route offers the advantage of once-weekly dosing, which may improve medication adherence compared to daily oral administration.