What is the recommended dosage and usage of Clonidine (Clonidine) Extended Release (ER) for treating hypertension and Attention Deficit Hyperactivity Disorder (ADHD)?

Clonidine ER Dosage and Usage for Hypertension and ADHD

For hypertension and ADHD, Clonidine ER should be initiated at 0.1 mg twice daily (morning and bedtime) for adults, with gradual titration by 0.1 mg increments weekly to a maximum of 0.4 mg daily for ADHD or up to 0.6-0.8 mg daily for hypertension, based on clinical response and tolerability. 1, 2

Dosing for Hypertension

• Initial dose: 0.1 mg tablet twice daily (morning and bedtime), with elderly patients potentially benefiting from a lower starting dose 1
• Maintenance dose: Increments of 0.1 mg per day may be made at weekly intervals until desired response is achieved 1
• Taking the larger portion of the daily dose at bedtime minimizes side effects like dry mouth and drowsiness 1
• Therapeutic doses commonly range from 0.2 mg to 0.6 mg daily in divided doses, with 2.4 mg being the maximum effective daily dose (rarely used) 1
• For patients with renal impairment, a lower initial dose is recommended with careful monitoring 1

Dosing for ADHD

• Initial dose: 0.05-0.1 mg at bedtime 2, 3
• Titration: Increase by 0.1 mg BID to TID to a maximum of 0.4 mg per day 2, 3
• Extended-release formulation has shown efficacy for ADHD in children and adolescents, with symptomatic improvement achieved following 2 weeks of treatment 4
• Clonidine ER is generally well tolerated both as monotherapy and as adjunctive therapy with stimulant regimens 4

Administration Considerations

• For hypertension, taking the larger portion of the daily dose at bedtime helps minimize transient adjustment effects 1
• For ADHD, evening dosing is often preferred due to sedative effects 3
• The full therapeutic effect may take 2-4 weeks to develop 3
• Clonidine must be tapered to avoid rebound hypertension; abrupt discontinuation can induce hypertensive crisis 5

Side Effects and Monitoring

• Common side effects include somnolence, fatigue, dry mouth, irritability, insomnia, and nightmares 3
• More serious concerns include hypotension, bradycardia, and syncope 3
• Regular monitoring of blood pressure and heart rate is essential 3
• Long-term therapy (10 years) has shown sustained blood pressure control with minimal side effects 6
• Rare but serious complications can include heart failure with significant troponemia in cases of overdose 7

Special Populations

Pregnancy and Breastfeeding

• Clonidine crosses the placental barrier and is found in human milk 5
• Limited published information indicates clonidine is likely not associated with adverse pregnancy or developmental outcomes 2
• Studies of clonidine use during pregnancy for hypertension or hyperemesis gravidarum have found no increased risk for major or minor malformations 2
• Breastfed infants should be monitored for drowsiness and hypotonia 2, 5
• Clonidine is found in human milk with an M:P ratio reported as 2 and a relative infant dose up to 7.1% 2

Elderly and Renal Impairment

• Elderly patients may benefit from a lower initial dose 1
• Patients with renal impairment should start with a lower dose and be carefully monitored 1
• Minimal amount of clonidine is removed during hemodialysis, so supplemental doses following dialysis are unnecessary 1

Clinical Pearls and Pitfalls

• Clonidine is primarily used as a last-line antihypertensive agent in adults due to significant CNS adverse effects 5
• For severe hypertension, rapid oral titration can be effective, starting with 0.2 mg followed by 0.1-0.2 mg hourly doses 8, 9
• When used for ADHD, clonidine can be considered as an adjunct agent following a risk-benefit discussion 2, 5
• Side effects tend to be most prominent during the first month of treatment and often diminish over time 6