What is clonidine used for in adults?

Uses of Clonidine in Adults

Clonidine is primarily used as a last-line antihypertensive agent in adults due to its significant CNS adverse effects, but it also has several off-label psychiatric and neurological applications. 1

Hypertension Management

• Clonidine is classified as a central alpha-2 agonist that works by stimulating alpha-adrenoreceptors in the brain stem, resulting in reduced sympathetic outflow and decreased blood pressure 2
• It is generally reserved as a last-line antihypertensive therapy due to significant CNS adverse effects, especially in older adults 1
• Typical oral dosing ranges from 0.1-0.8 mg daily, usually divided into two doses 1, 2
• Available in both oral tablet form (0.1-0.8 mg daily in divided doses) and transdermal patch (0.1-0.3 mg weekly) 1
• Can be effective in all grades of hypertension, including refractory hypertension when combined with other agents 3

Psychiatric and Neurological Applications

• FDA-approved for treatment of attention-deficit/hyperactivity disorder (ADHD) in the long-acting formulation 4
• Used as an adjunct agent in the treatment of ADHD in adults, though with limited information on both safety and efficacy 1
• Utilized for opiate detoxification and withdrawal management 4
• Employed in the treatment of post-traumatic stress disorder (PTSD) 4
• Helpful in managing Tourette syndrome 4
• Used for treating neuroleptic-induced akathisia and stimulant-induced insomnia 4

Special Populations

• Elderly patients may benefit from a lower initial dose due to increased sensitivity 2
• Can be safely administered to patients with congestive heart failure, ischemic heart disease, obstructive lung disease, and chronic renal insufficiency 5
• Patients with renal impairment may require lower initial doses with careful monitoring 2

Important Precautions

• Must avoid abrupt discontinuation of clonidine, which can induce hypertensive crisis; medication must be tapered to avoid rebound hypertension 1
• Sedation and dry mouth are common side effects, usually dose-related 5
• Taking the larger portion of the daily dose at bedtime may minimize transient adjustment effects 2
• Clonidine crosses the placental barrier and is found in human milk; caution is advised during pregnancy and breastfeeding 1, 2
• Breastfed infants should be monitored for drowsiness and hypotonia when mothers are taking clonidine 1

Dosing Considerations

• Initial dose typically 0.1 mg twice daily (morning and bedtime) 2
• Maintenance dose can be increased by 0.1 mg per day at weekly intervals until desired response is achieved 2
• Therapeutic doses commonly range from 0.2 mg to 0.6 mg per day in divided doses 2
• Maximum effective daily dose is 2.4 mg, though doses this high are rarely employed 2

Clonidine's versatility makes it valuable in multiple clinical scenarios, though its side effect profile often relegates it to second or third-line therapy for most indications.