Clonidine Dosing Guidelines
For hypertension in adults, clonidine should be administered at an initial dose of 0.1 mg twice daily (morning and bedtime), with weekly increments of 0.1 mg per day as needed, up to a maximum effective daily dose of 2.4 mg. 1, 2
Standard Dosing for Hypertension
- Initial dose: 0.1 mg tablet twice daily (morning and bedtime)
- Titration: Increase by 0.1 mg per day at weekly intervals as needed
- Maintenance dose: Most commonly 0.2-0.6 mg per day in divided doses
- Maximum effective dose: 2.4 mg per day (rarely needed)
- Administration strategy: Taking the larger portion at bedtime minimizes side effects like dry mouth and drowsiness 2
Special Populations
- Elderly patients: May benefit from lower initial doses 2
- Renal impairment: Lower initial doses recommended with careful monitoring
- Hemodialysis patients: No supplemental dose needed following dialysis 2
Hypertensive Urgencies
For severe hypertension/hypertensive urgencies, a rapid oral loading approach can be used:
- Initial dose of 0.2 mg
- Followed by 0.1 mg hourly
- Until blood pressure goal is reached or maximum of 0.7-0.8 mg total dose
- This approach has shown 82-93% success rate in controlling severe hypertension 3, 4, 5
Important Precautions
- Never abruptly discontinue clonidine due to risk of severe rebound hypertension 1
- Clonidine must be tapered gradually when discontinuing
- Generally reserved as last-line therapy due to significant CNS adverse effects, especially in older adults 1
Side Effects to Monitor
- Sedation and drowsiness (most common)
- Dry mouth
- Orthostatic hypotension
- Bradycardia
- Dizziness
Dosing Schedule Considerations
Research suggests that divided dosing schedules provide more consistent blood pressure control than once-daily dosing 6. A twice-daily regimen with a larger evening dose and smaller morning dose may offer the best balance between:
- Effective blood pressure control
- Minimizing daytime sedation
- Patient convenience
Clonidine Patch Alternative
- Transdermal clonidine patch: 0.1-0.3 mg released per day
- Applied once weekly
- May be preferred for patients with adherence concerns or those experiencing significant side effects with oral administration 1
Remember that clonidine is generally considered a last-line agent for hypertension due to its side effect profile, particularly CNS effects. When initiating therapy, close monitoring of blood pressure and heart rate is essential, especially during dose adjustments.