Clonidine Indications and Dosages

Clonidine is primarily indicated for the treatment of hypertension, either alone or in combination with other antihypertensive agents. 1

Primary Indications

Hypertension: FDA-approved as monotherapy or in combination with other antihypertensive medications 1
Menopausal hot flashes: Shown to have mild to moderate efficacy, reducing hot flashes by up to 46% 2
ADHD: Can be considered as an adjunct agent in the treatment of ADHD following a risk-benefit discussion 2

Initial dose: 0.1 mg tablet twice daily (morning and bedtime) 1
Maintenance dose: May increase by 0.1 mg per day at weekly intervals until desired response is achieved 1
Typical therapeutic range: 0.2 mg to 0.6 mg per day in divided doses 1
Maximum effective daily dose: 2.4 mg, though doses this high are rarely used 1
Elderly patients: May benefit from a lower initial dose 1
Administration tip: Taking the larger portion of the daily dose at bedtime may minimize side effects like dry mouth and drowsiness 1

Initial dose: 0.1-0.2 mg orally 3
Followed by: Hourly doses of 0.05-0.1 mg until goal blood pressure is attained or a total of 0.7 mg is given 3
Success rate: Achieves significant blood pressure reduction in 93% of patients 3

Renal impairment: Patients may benefit from a lower initial dose and should be carefully monitored 1
Hemodialysis patients: No need for supplemental dosing following dialysis as minimal clonidine is removed during routine hemodialysis 1
Pregnancy: Limited published information indicates clonidine is likely not associated with adverse pregnancy outcomes; could be considered after risk-benefit discussion 2
Breastfeeding: Limited data available; majority of cases report no adverse effects, but one case reported infant drowsiness, hypotonia, and suspected seizures that resolved within 24 hours of breastfeeding cessation 2

Oral tablets: Most common form for hypertension treatment 1
Transdermal patch: Provides steady-state concentrations with less peak-to-trough fluctuation than oral dosing 4
- Steady-state plasma concentrations typically reached on the fourth day after initial application 4
- Designed to provide effective doses for at least 7 days 4

Common side effects: Monitor for orthostatic hypotension, drowsiness, dry mouth, and sedation 5
Critical warning: Avoid abrupt discontinuation, which may induce hypertensive crisis; clonidine must be tapered to avoid rebound hypertension 2, 5
Therapeutic window: Narrow therapeutic window - the plasma concentration for 50% maximal depressor effect (0.65 ng/ml) is only separated by a factor of 2 from the half maximal pressor concentration 6
Usage consideration: Generally reserved as a last-line agent due to significant CNS adverse effects, especially in older adults 2, 5
Breastfeeding monitoring: Infants should be monitored for drowsiness and hypotonia 2

Clonidine can be effectively used with or without a diuretic in elderly hypertensive patients 7
For hypertensive urgencies, oral clonidine rapid titration provides smooth, predictable blood pressure reduction with lower overall cost and reduced need for hospitalization 3
When used for hot flashes, doses typically don't affect blood pressure 2
Discontinuation rates due to side effects in hot flash treatment trials were approximately 40%, higher than with SSRI/SNRIs (10-20%) 2