What is the typical dosing and frequency of the clonidine (clonidine) patch?

Clonidine Patch Dosing and Administration

The clonidine transdermal patch should be applied once every 7 days to a hairless area of intact skin on the upper outer arm or chest, with therapy typically initiated at the 0.1 mg patch strength and titrated according to blood pressure response. 1

Patch Application and Dosing

• Apply the patch to a different skin site from the previous location to avoid skin irritation 1
• Initial therapy should start with the Clonidine Transdermal System 0.1 mg patch 1
• If desired blood pressure reduction is not achieved after 1-2 weeks, increase dosage by:
  • Adding another 0.1 mg patch, or
  • Changing to a larger system (0.2 mg or 0.3 mg) 1
• Dosing above two 0.3 mg patches is usually not associated with additional efficacy 1
• Maximum blood pressure reduction occurs 2-3 days after initial application 2
• Steady-state plasma concentrations are typically reached on the fourth day after initial application 2

Transitioning from Oral Clonidine

• When substituting the patch for oral clonidine, be aware that the antihypertensive effect may not begin until 2-3 days after initial application 1
• Gradual reduction of prior oral medication is advised 1
• Some or all previous antihypertensive treatment may need to be continued, particularly in patients with more severe hypertension 1

Special Considerations

• If the patch loosens during the 7-day wearing period, an adhesive cover should be applied directly over the system to ensure good adhesion 1
• In patients with renal impairment, dosage must be adjusted according to the degree of impairment with careful monitoring 1
• For patients on hemodialysis, there is no need for supplemental clonidine following dialysis as only minimal amounts are removed during routine hemodialysis 1

Patch Strengths and Delivery

• The rate at which clonidine is delivered to the skin is controlled by a microporous membrane 2
• The daily dose is regulated by the area of skin covered by the patch 2
• Available patch strengths correspond to the amount of drug delivered per day:
  • 0.1 mg/day (3.5 cm² patch)
  • 0.2 mg/day (7.0 cm² patch)
  • 0.3 mg/day (10.5 cm² patch) 2

Monitoring and Precautions

• Monitor for common side effects including orthostatic hypotension, drowsiness, dry mouth, and sedation 3
• Avoid abrupt discontinuation of clonidine, which may induce hypertensive crisis; clonidine must be tapered to avoid rebound hypertension 3
• Plasma clonidine concentration from a particular transdermal dose varies considerably between individuals due to differences in renal clearance 2
• Using whole patches rather than cut patches provides more predictable absorption rates and plasma concentrations 4

Important Cautions

• Clonidine is generally reserved as a last-line agent due to significant CNS adverse effects, especially in older adults 3
• There have been rare reports of the need for patch changes prior to the 7-day period to maintain blood pressure control 1
• For pediatric patients, whole patches provide more predictable absorption compared to cut patches 4