Clonidine Dosing Instructions
For hypertension in adults, clonidine should be initiated at 0.1 mg tablet twice daily (morning and bedtime), with further increments of 0.1 mg per day at weekly intervals until desired blood pressure response is achieved, with therapeutic doses typically ranging from 0.2 mg to 0.6 mg per day in divided doses. 1
Initial Dosing
- Start with 0.1 mg tablet twice daily (morning and bedtime) 1
- Elderly patients may benefit from a lower initial dose 1
- Taking the larger portion of the daily dose at bedtime can minimize transient side effects like dry mouth and drowsiness 1
Maintenance and Titration
- Increase by 0.1 mg per day at weekly intervals if necessary until desired response is achieved 1
- Therapeutic doses commonly range from 0.2 mg to 0.6 mg per day given in divided doses 1
- Maximum effective daily dose is 2.4 mg, though doses this high are rarely used 1
Special Populations
- Patients with renal impairment may benefit from a lower initial dose 1
- No supplemental dose is needed following hemodialysis as minimal clonidine is removed during routine dialysis 1
For ADHD (Off-Label Use)
- Usual starting dose: 0.05-0.1 mg orally at bedtime 2
- Titration: Increase by 0.1 mg BID to TID to a maximum of 0.4 mg per day 2
Important Monitoring Parameters
- Hold clonidine if systolic blood pressure <90 mmHg 3
- Hold clonidine if diastolic blood pressure <60 mmHg 3
- Hold clonidine if heart rate <50 beats per minute 3
- Monitor for orthostatic changes, especially in elderly patients 3
- Check blood pressure and heart rate before each dose 3
Critical Precautions
- Clonidine must be tapered to avoid rebound hypertension; abrupt discontinuation can induce hypertensive crisis 4, 3
- Risk of rebound hypertension is highest when clonidine is suddenly stopped after prolonged use 3
- For hypertensive urgencies, an initial oral dose of 0.1-0.2 mg followed by hourly doses of 0.05-0.1 mg (up to 0.7 mg total) can achieve significant blood pressure reduction in 93% of patients 5
- Therapeutic window is narrow - at plasma concentration of 0.65 ± 0.07 ng/ml, 50% of maximal depressor effect is achieved, but this is only separated by a factor of 2 from the half maximal pressor concentration 6
Pregnancy and Breastfeeding Considerations
- Limited published information indicates clonidine is likely not associated with adverse pregnancy or developmental outcomes 2
- Clonidine is found in human milk with a milk-to-plasma ratio reported as 2 with a relative infant dose up to 7.1% 2
- Breastfed infants should be monitored for drowsiness and hypotonia 2, 4
- One case report noted an infant developing drowsiness, hypotonia, suspected seizures, and apnea episodes with maternal dose of 0.15 mg daily; symptoms resolved within 24 hours of breastfeeding cessation 2