Clonidine Dosing for Blood Pressure Control
For blood pressure control in adults, clonidine should be initiated at 0.1 mg twice daily (morning and bedtime), with increments of 0.1 mg per day at weekly intervals as needed until the desired response is achieved, with therapeutic doses typically ranging from 0.2 mg to 0.6 mg per day given in divided doses. 1
Initial Dosing and Titration
- Start with 0.1 mg tablet twice daily (morning and bedtime) for most patients 1
- Elderly patients may benefit from a lower initial dose 1
- Increase dose by 0.1 mg per day at weekly intervals if necessary until desired blood pressure response is achieved 1
- Taking the larger portion of the daily dose at bedtime may minimize side effects such as dry mouth and drowsiness 1
Typical Therapeutic Range
- Most commonly employed therapeutic doses range from 0.2 mg to 0.6 mg per day in divided doses 1
- Maximum effective daily dose is 2.4 mg, though doses this high are rarely needed 1, 2
- High doses of clonidine (above 1.2 mg daily) may paradoxically raise rather than lower blood pressure 2
Special Populations
- Patients with renal impairment should receive a lower initial dose with careful monitoring 1
- No supplemental dosing is needed following hemodialysis as minimal amounts of clonidine are removed during routine dialysis 1
Place in Hypertension Treatment Algorithm
- Clonidine is not typically a first-line agent for hypertension but is used as an add-on therapy in resistant hypertension 3
- In treatment algorithms for both black and non-black patients, clonidine is usually considered after initial therapies (ACEIs/ARBs, calcium channel blockers, thiazide diuretics) have failed 3
- Clonidine is typically added after spironolactone, or if spironolactone is not tolerated or contraindicated 3, 4
Hypertensive Urgencies/Emergencies
- For hypertensive urgencies, an oral loading dose approach can be used: 0.2 mg initially, followed by 0.1 mg hourly until blood pressure is controlled or maximum dose reached 3, 5
- This oral loading approach has shown a 93% success rate in achieving significant blood pressure reduction 5
- The average dose needed for hypertensive emergencies is approximately 0.5 mg, with response typically occurring within 1-2 hours 6, 7
Important Cautions
- Abrupt discontinuation can lead to severe rebound hypertension 3
- Common side effects include sedation and dry mouth 3
- Target blood pressure reduction should be at least 20/10 mmHg, ideally toward 140/90 mmHg 8
- Avoid excessive or too rapid blood pressure reduction, which can lead to organ hypoperfusion 8