Parameters for Initiating and Adjusting Clonidine Therapy
For adult hypertension patients, clonidine therapy should be initiated at 0.1 mg twice daily (morning and bedtime), with increments of 0.1 mg per day made at weekly intervals until desired response is achieved, with typical therapeutic doses ranging from 0.2-0.6 mg per day. 1
Initial Dosing Parameters
Adults with Hypertension
- Starting dose: 0.1 mg tablet twice daily (morning and bedtime)
- Elderly patients: May benefit from a lower initial dose
- Renal impairment: Lower initial dose recommended with careful monitoring
- Maximum effective daily dose: 2.4 mg (rarely employed)
Children with ADHD or Hypertension
- Children ≥12 years: 0.2 mg/day initially 2
- Dosing frequency: Twice daily (BID)
- Maximum dose: 2.4 mg/day
Dose Adjustment Parameters
Hypertension Management
- Incremental increases: 0.1 mg per day at weekly intervals
- Timing strategy: Taking larger portion of daily dose at bedtime minimizes side effects (dry mouth, drowsiness)
- Therapeutic range: 0.2-0.6 mg daily in divided doses 1
- Monitoring: Blood pressure response should guide dosage adjustments
Hypertensive Urgency (Oral Loading)
- Initial oral dose: 0.1-0.2 mg
- Follow-up doses: 0.05-0.1 mg hourly
- Maximum loading dose: 0.7 mg total
- Target: Until goal blood pressure is achieved without reducing perfusion to critical organs 3
Perioperative Pain Management
- Preservative-free clonidine for epidural use: 1-2 μg/kg
- Continuous infusion rate: 0.2-0.4 μg/kg/hour 2
Special Populations
Elderly Patients
- Start with lower initial doses
- Monitor more closely for orthostatic hypotension and sedation
- Adjust dose more gradually
Renal Impairment
- Lower initial dose recommended
- No supplemental dose needed following hemodialysis 1
Monitoring Parameters
Initial Phase
- Blood pressure: Monitor regularly during dose titration
- Heart rate: Watch for bradycardia
- Sedation level: Assess for excessive drowsiness
- Orthostatic changes: Check for postural hypotension
Long-term Monitoring
- Blood pressure control: Regular assessment of efficacy
- Side effects: Dry mouth, drowsiness, dizziness
- Renal function: Periodic assessment of serum creatinine
Important Precautions
- Abrupt discontinuation: Avoid sudden cessation as it can lead to severe rebound hypertension 2
- Sedative effects: Use caution when performing activities requiring alertness
- Cardiovascular risk: Not recommended for perioperative initiation to reduce cardiovascular risk 2
- Concomitant medications: Monitor for interactions, particularly with other antihypertensives
Formulation Options
- Oral tablets: 0.1 mg and 0.2 mg strengths
- Transdermal system: Provides steady-state concentrations with less peak-to-trough fluctuation 4
- Preservative-free injectable: For epidural or regional anesthesia adjunct 2
Side Effect Management
- Dry mouth: Ensure adequate hydration, consider oral moisturizers
- Drowsiness: Administer larger portion of dose at bedtime
- Constipation: Increase fluid and fiber intake
- Fatigue: Monitor and adjust dosing schedule if significant
Clonidine's effectiveness must be balanced against its side effect profile. Starting with small doses and careful titration helps minimize patient resistance due to side effects while achieving therapeutic goals 5.