Clonidine Dosing for Hyperhidrosis

For treating hyperhidrosis (excessive sweating), oral clonidine is typically dosed at 0.1 mg/day to 0.4 mg/day, divided into two daily doses. 1

Dosage Recommendations

Oral clonidine for hyperhidrosis is typically started at 0.1 mg at bedtime, then gradually increased by 0.1 mg every few days until an effective dose is reached 1, 2
The effective dose range is typically 0.1-0.4 mg per day, with most patients responding to approximately 0.3 mg daily 1, 2
Higher doses (up to 0.8 mg daily) may be used in some cases but are generally not recommended due to increased risk of side effects 1
For facial and scalp hyperhidrosis specifically, doses of 0.3-0.4 mg daily (with 0.25 mg taken at bedtime to prevent daytime sedation) have shown effectiveness 2
Alternative dosing: 0.075 mg three times daily has been reported effective for paroxysmal localized hyperhidrosis 3

Dividing the daily dose into two administrations (BID) is recommended to maintain steady blood levels 1
Taking a larger portion of the dose at bedtime may help minimize daytime sedation 2
Transdermal clonidine patches (0.1-0.3 mg released weekly) are available but less commonly used for hyperhidrosis 1

For axillary and palmoplantar hyperhidrosis, clonidine is generally considered a third-line treatment after topical agents and botulinum toxin injections 4
For craniofacial hyperhidrosis, oral medications including clonidine are considered first-line therapy 4
Response to treatment typically begins within 1-2 weeks, with full effect seen within 2-3 weeks 2, 3

Clonidine is generally reserved as a later-line treatment option due to significant CNS adverse effects, especially in older adults 1
Blood pressure monitoring is recommended as clonidine is primarily an antihypertensive medication 1
Avoid abrupt discontinuation of clonidine, which may induce hypertensive crisis; the medication must be tapered to avoid rebound hypertension 1
Common side effects include dry mouth, drowsiness, dizziness, and sedation 1
Doses used for treating hyperhidrosis do not typically affect blood pressure in normotensive individuals 1

Use with caution in elderly patients due to increased risk of CNS side effects 1
In pregnancy, clonidine should be used with caution and only after careful risk-benefit assessment 1
For children with hyperhidrosis, lower doses based on weight may be considered, though evidence is limited 1

Clonidine appears to have mild to moderate efficacy in reducing excessive sweating, with studies showing reduction of hot flashes by up to 46% 1
Alternative oral medications for hyperhidrosis include glycopyrrolate, which may have fewer CNS side effects 4
Discontinuation rates due to side effects in clinical trials for hot flashes were approximately 40% for clonidine, compared to 10-20% for SSRIs/SNRIs 1