General Prescription Instructions for PRN Clonidine
PRN clonidine should be prescribed at 0.03-0.05 mg/kg per dose orally every 3-4 hours as needed, with careful monitoring for side effects including sedation, dry mouth, and hypotension. 1
Dosing Guidelines
- For adults requiring PRN clonidine, the standard initial dose is 0.1 mg tablet twice daily (morning and bedtime), with elderly patients potentially benefiting from a lower initial dose 2
- For children, PRN clonidine dosing is specifically recommended at 0.03-0.05 mg/kg per dose orally every 3-4 hours as needed 1
- Standing (scheduled) clonidine dosing for children is typically 1 mcg/kg orally every 4 hours 1
- Maximum daily dose for adults should not exceed 2.4 mg, though doses this high are rarely employed 2
Administration Considerations
- When using clonidine on a scheduled basis, taking the larger portion of the daily dose at bedtime may minimize transient adjustment effects such as dry mouth and drowsiness 2
- For patients with renal impairment, a lower initial dose is recommended with careful monitoring 2
- Hemodialysis removes only minimal amounts of clonidine, so supplemental dosing following dialysis is not necessary 2
Monitoring Requirements
- Blood pressure and heart rate monitoring is required during clonidine treatment 1
- Particular attention should be paid to signs of hypotension, especially when initiating therapy 3
- For PRN use, document the indication, response, and any side effects to guide future dosing 1, 3
Important Precautions
- Sudden cessation of clonidine therapy can lead to severe rebound hypertension, so patients must be educated about adherence 1, 3
- If transitioning from PRN to scheduled dosing, implement a gradual schedule to avoid withdrawal symptoms 3
- Clonidine may cause significant sedation, dry mouth, and dizziness which can impact quality of life 3
- Use with caution in elderly patients due to increased risk of central nervous system effects 3
Special Populations
- In pediatric patients, clonidine is often used as a secondary agent for conditions like neonatal opioid withdrawal syndrome 1
- For children ≥12 years, the typical starting dose is 0.2 mg/day 1
- Careful dose calculation based on weight is essential in pediatric patients to avoid toxicity 4
- Compounding and liquid dosing errors are common in children and may result in significant overdoses, so precise instructions for caregivers are critical 4
Formulation Considerations
- Clonidine is available in oral tablets and transdermal patches, with the latter providing more consistent blood levels 5
- For patients unable to swallow tablets, compounded suspensions may be used but require careful preparation and dosing instructions 4
- When using compounded liquid formulations, provide calibrated measuring devices and clear instructions to prevent dosing errors 4