Clonidine (Catapres) Dosage and Usage Guidelines
For adults with hypertension, clonidine hydrochloride tablets should be initiated at 0.1 mg twice daily (morning and bedtime), with maintenance doses ranging from 0.2 mg to 0.6 mg per day in divided doses. 1
Adult Dosing for Hypertension
Initial Dosing
- Start with 0.1 mg tablet twice daily (morning and bedtime)
- Elderly patients may benefit from a lower initial dose 1
- Taking the larger portion at bedtime minimizes side effects like dry mouth and drowsiness
Maintenance Dosing
- Increments of 0.1 mg per day may be made at weekly intervals as needed
- Therapeutic doses commonly range from 0.2 mg to 0.6 mg per day in divided doses
- Maximum effective daily dose is 2.4 mg, though doses this high are rarely used 1
Special Populations
- Patients with renal impairment should start with a lower initial dose
- No supplemental dosing needed following hemodialysis 1
Administration Considerations
Optimizing Tolerability
- Taking the larger portion of the daily dose at bedtime minimizes transient side effects 1
- Side effects like sedation and dry mouth are usually dose-related and can be minimized by gradual dose increases 2
Monitoring Requirements
- Blood pressure should be carefully monitored, especially during initiation and dose adjustments
- Cardiovascular monitoring is recommended, including personal and family cardiac history 3
- Consider ECG if risk factors are present 3
Important Precautions
Discontinuation
- Clonidine must be tapered gradually to prevent rebound hypertension upon discontinuation 3
- Never abruptly stop clonidine therapy
Side Effects to Monitor
- Common side effects: somnolence, sedation, dry mouth, dizziness, irritability, headache
- Cardiovascular effects: bradycardia and hypotension 3
Use in Special Conditions
ADHD Treatment
- Extended-release clonidine is recommended as a second-line or adjunctive therapy for ADHD 3
- Particularly useful in ADHD with comorbid conditions like sleep disturbances, tics, or autism spectrum disorder 3
- Not recommended for children under 6 years 3
Cardiovascular Considerations
- Use with extreme caution in patients with heart failure 3
- Can be safely given to patients with ischemic heart disease when properly monitored 2
Clinical Pearls
- Clonidine is versatile and effective for hypertension management 2
- It can be safely used in patients with congestive heart failure, ischemic heart disease, obstructive lung disease, chronic renal insufficiency, and diabetes mellitus when properly monitored 2
- For severe hypertension, rapid oral titration protocols exist starting with 0.1-0.2 mg followed by hourly doses of 0.05-0.1 mg until target blood pressure is achieved 4