Recommended Dosage of Clonidine for Anxiety
For anxiety treatment, clonidine should be started at 0.05-0.1 mg orally at bedtime, with gradual increases as needed up to a maximum of 0.4 mg per day divided into 2-3 doses. 1
Initial Dosing
- Start with 0.1 mg tablet twice daily (morning and bedtime) for adults, with elderly patients potentially benefiting from a lower initial dose 2
- For anxiety-specific treatment, starting with 0.05-0.1 mg at bedtime is recommended to minimize side effects 1
- Taking the larger portion of the daily dose at bedtime can minimize transient adjustment effects like dry mouth and drowsiness 2
Dose Titration
- Further increments of 0.1 mg per day may be made at weekly intervals if necessary until desired response is achieved 2
- Dose can be increased gradually to 0.1 mg BID-TID to a maximum of 0.4 mg per day 1
- Therapeutic doses most commonly employed range from 0.2 mg to 0.6 mg per day given in divided doses 2
Special Populations
- Patients with renal impairment may benefit from a lower initial dose with careful monitoring 2
- No need for supplemental clonidine following dialysis as only minimal amounts are removed during routine hemodialysis 2
Efficacy for Anxiety
- Short-term studies have shown anxiolytic effects in patients with panic disorder, though these effects may not persist with long-term administration in most patients 3
- Studies in high-anxiety individuals have shown that clonidine can reduce anxiety levels and increase frontal midline theta activity (Fm theta), which indicates relief from anxiety 4
Specific Applications
- Clonidine has been used for PTSD-associated nightmares at doses ranging from 0.1-0.5 mg/day (median 0.15 mg/day) 5
- For PTSD-associated nightmares, doses of 0.2-0.6 mg in divided doses have shown efficacy 1
- During opioid tapering, clonidine can help manage withdrawal symptoms, though specific dosing for this indication isn't clearly established in the guidelines 1
Monitoring and Side Effects
- Monitor for common side effects including orthostatic hypotension, drowsiness, dry mouth, and sedation 1
- Avoid abrupt discontinuation of clonidine, which may induce hypertensive crisis; clonidine must be tapered to avoid rebound hypertension 1
- Clonidine is generally reserved as a last-line agent due to significant CNS adverse effects, especially in older adults 1
Important Considerations
- The maximum studied effective daily dose is 2.4 mg, but doses this high are rarely employed 2
- For severe anxiety requiring rapid control, an initial oral dose of 0.1-0.2 mg followed by hourly doses of 0.05-0.1 mg (up to a total of 0.7 mg) has been used in hypertensive urgencies, which might be applicable to severe anxiety with autonomic hyperarousal 6
- Clonidine is classified as a central alpha-2 agonist that suppresses sympathetic nervous system outflow throughout the brain, which is the mechanism behind its anxiolytic effects 1