Clonidine Dosing Recommendations
For hypertension, clonidine should be initiated at 0.1 mg twice daily (morning and bedtime), with the larger portion at bedtime, and titrated by 0.1 mg per day at weekly intervals until desired response is achieved, with typical therapeutic doses ranging from 0.2-0.6 mg/day. 1, 2
Dosing Guidelines for Hypertension
- Initial dose: 0.1 mg tablet twice daily (morning and bedtime) 1
- Titration: Increase by 0.1 mg per day at weekly intervals as needed 1
- Maintenance dose: 0.2-0.6 mg per day in divided doses 1
- Maximum dose: 2.4 mg daily (rarely employed) 1
- Elderly patients: May benefit from a lower initial dose 1
- Administration strategy: Taking the larger portion at bedtime minimizes daytime sedation and dry mouth 2, 1
Special Populations
- Renal impairment: Start with lower initial dose and monitor carefully 1
- Hemodialysis patients: No supplemental dose needed following dialysis as minimal clonidine is removed 1
Alternative Dosing Strategies
Research has shown that different dosing schedules affect both efficacy and side effect profiles:
- Twice-daily dosing with larger evening dose provides better blood pressure control while minimizing daytime drowsiness compared to once-daily or thrice-daily regimens 3
- Three-times-daily dosing provides better blood pressure control than once-daily dosing but has higher incidence of daytime drowsiness 3
Dosing for Other Indications
- PTSD-associated nightmares: 0.2-0.6 mg in divided doses 4
- ADHD: Starting dose of 0.05-0.1 mg at bedtime, maximum 0.4 mg/day 2
Important Considerations and Precautions
- Clonidine is generally reserved as a last-line agent for hypertension due to significant CNS adverse effects, especially in older adults 4, 2
- Avoid abrupt discontinuation which may induce hypertensive crisis; taper gradually over 2-4 days 4, 2
- Common side effects: Drowsiness, dry mouth, fatigue, hypotension, and dizziness 2
- Orthostatic hypotension risk is higher in older adults 2
Monitoring Recommendations
- Regular monitoring of pulse and blood pressure, especially when initiating therapy 2
- Consider baseline ECG if cardiac risk factors are present 2
Hypertensive Emergencies
For hypertensive urgencies, an oral loading and titration approach may be considered:
- Initial oral dose of 0.1-0.2 mg
- Followed by hourly doses of 0.05-0.1 mg until goal blood pressure is attained or a total of 0.7 mg is given 5
- This approach achieves significant blood pressure reduction in 93% of patients 5
The dose-dependent suppression of norepinephrine appearance rate in plasma explains clonidine's antihypertensive effect, with higher doses producing greater suppression of sympathetic nervous system activity 6.
Human Dosage Forms
- Oral tablets: 0.1 mg, 0.2 mg, 0.3 mg
- Transdermal patches: Available in various sizes for weekly application 7