Clonidine Dosing for Night Sweats
For night sweats, clonidine can be administered at a dose of 0.1 mg twice daily initially, with gradual titration up to 0.2-0.6 mg daily in divided doses based on response and tolerability. 1
Dosing Regimen
- Start with 0.1 mg twice daily (morning and bedtime) as the initial dose 1
- Elderly patients may benefit from a lower initial dose 1
- Increase by 0.1 mg per day at weekly intervals if necessary until desired response is achieved 1
- Taking the larger portion of the daily dose at bedtime may minimize side effects such as dry mouth and drowsiness 1
- For night sweats specifically, doses of 0.1-0.2 mg at bedtime have shown efficacy 2
- For PTSD-associated nightmares, doses of 0.2-0.6 mg daily (in divided doses) have been effective 2
Mechanism of Action for Night Sweats
- Clonidine is an α2-adrenergic receptor agonist that suppresses sympathetic nervous system outflow throughout the brain 2
- It produces a dose-dependent reduction in norepinephrine appearance rate in plasma, which may help reduce night sweats 3
- Clonidine decreases vasoconstriction and shivering thresholds without affecting the sweating threshold, which helps regulate temperature control during sleep 4
- Low-dose clonidine increases REM sleep while medium-dose clonidine decreases REM sleep and increases N2 sleep, which may contribute to its effects on night sweats 2
Evidence for Efficacy
- Clonidine has shown mild to moderate efficacy in treating menopausal hot flashes, reducing them by up to 46% 2
- In tamoxifen users with breast cancer history, transdermal clonidine (0.1 mg/day) or oral clonidine (0.1 mg/day) reduced frequency and severity of hot flashes 2
- For PTSD-associated nightmares, case series have demonstrated efficacy of 0.2-0.6 mg clonidine in divided doses 2
- In a 2-week pilot study, 0.1 mg clonidine twice daily decreased frequency of nightmares in patients with PTSD 2
Monitoring and Side Effects
- Monitor for orthostatic hypotension, especially when increasing doses 2
- Common side effects include dry mouth and insomnia or drowsiness 2
- Clonidine can cause significant sedation - a morning dose of 0.25-0.3 mg produced profound sedation in one study 5
- Avoid abrupt discontinuation as this may induce hypertensive crisis; clonidine must be tapered to avoid rebound hypertension 2
- Doses used specifically for treating hot flashes generally do not significantly affect blood pressure 2
Special Considerations
- For patients with renal impairment, start with a lower initial dose and monitor carefully 1
- No supplemental dosing is needed following hemodialysis 1
- Clonidine is generally reserved as a later-line therapy for hot flashes/night sweats due to CNS adverse effects, especially in older adults 2
- For PTSD-related night sweats, prazosin (an alpha-1 blocker) is considered first-line with stronger evidence (Level A recommendation) compared to clonidine (Level C recommendation) 2