Clonidine Dosing Guidelines
For hypertension in adults, clonidine should be started at 0.1 mg twice daily (morning and bedtime) with gradual titration by 0.1 mg increments weekly until desired blood pressure response is achieved, with most therapeutic doses ranging from 0.2-0.6 mg/day and a maximum effective daily dose of 2.4 mg. 1, 2
Dosing for Hypertension
Adults
- Initial dose: 0.1 mg tablet twice daily (morning and bedtime)
- Maintenance dose: Increments of 0.1 mg per day at weekly intervals until desired response
- Typical therapeutic range: 0.2-0.6 mg/day in divided doses
- Maximum effective daily dose: 2.4 mg (rarely needed)
- Administration tip: Taking larger portion at bedtime minimizes dry mouth and drowsiness 2
Elderly
- Start with lower initial dose
- Careful monitoring for orthostatic hypotension 2
Renal Impairment
- Lower initial dose
- Close monitoring
- No supplemental dose needed after hemodialysis 2
Dosing for ADHD
Children and Adolescents
- Starting dose: 0.05 mg at bedtime 3
- Titration: Increase slowly
- Maximum dose: Should not exceed 0.3 mg/day when used with stimulants 3
- Extended-release formulation (Kapvay): FDA-approved for ADHD in children 6-17 years 3, 4
Hypertensive Urgencies/Emergencies
- Initial dose: 0.1-0.2 mg orally
- Follow-up dosing: 0.05-0.1 mg hourly until goal BP or maximum 0.7-0.8 mg
- Success rate: 93% of patients achieve significant BP reduction 5, 6
- Mean effective dose: 0.32 mg
- Mean response time: 1.8 hours 6
Important Administration Considerations
Never abruptly discontinue - Must taper gradually to avoid rebound hypertension/hypertensive crisis 1
Monitoring requirements:
- Blood pressure and heart rate, especially during initiation
- Signs of orthostatic hypotension
- Sedation and alertness 3
Special populations:
- Use with caution in patients with cardiac issues
- Not recommended for children under 6 years
- Avoid in patients with depression 3
Side Effects and Precautions
- Common side effects: Sedation, dry mouth, drowsiness
- Cardiovascular effects: Risk of bradycardia and hypotension
- CNS effects: Significant adverse effects, especially in older adults 1
- Classification: Generally reserved as last-line therapy for hypertension due to CNS side effects 1
Comparison with Guanfacine
- Clonidine is approximately 10 times more potent than guanfacine
- Clonidine binds to all alpha-2 receptor subtypes (A, B, C) while guanfacine has higher specificity for alpha-2A receptors
- Clonidine has more pronounced sedation
- Clonidine typically requires twice-daily dosing, while guanfacine can be administered once daily 3
Clinical Pearls
- For hypertension, taking the larger portion of the daily dose at bedtime may minimize side effects 2
- For ADHD, clonidine is particularly beneficial for hyperarousal, hyperactivity, and aggression 3
- Extended-release clonidine has evidence supporting its use as adjunctive therapy with stimulant medications for ADHD 3, 4
- Rapid oral titration can be effective for severe hypertension, even in ambulatory settings, but requires careful monitoring 5, 6