What is the starting dose of clonidine (antihypertensive medication) for a 5-year-old child?

Starting Dose of Clonidine for a Five-Year-Old

The recommended starting dose of clonidine for a 5-year-old child is 0.05 mg at bedtime, which should be gradually increased based on clinical response and tolerability. 1

Dosing Guidelines by Indication

For ADHD or Behavioral Symptoms

• Initial dose: 0.05-0.1 mg orally at bedtime 2, 1
• Titration: Increase by 0.1 mg divided 2-3 times daily to a maximum of 0.4 mg per day 2, 3
• Studies in children with autism spectrum disorder aged 5-13 years used doses of 0.15-0.20 mg divided three times daily, but this represents a titrated dose, not a starting dose 2

For Insomnia/Sleep Disturbances

• Initial dose: 0.05 mg at bedtime 1
• Maximum daily dose: Should not exceed 0.3 mg/day to minimize adverse effects 1
• A dose of 0.2 mg as an initial dose is considered too high for pediatric patients and increases the risk of adverse effects 1

Critical Safety Considerations

Why Starting Low is Essential

• Toxicity threshold: Severe effects (coma, respiratory depression) have been reported with doses as low as 0.3 mg (0.015 mg/kg) in young children 4
• Children under 4 years require direct medical evaluation for unintentional ingestions of ≥0.1 mg 4
• Doses exceeding 0.02 mg/kg commonly cause apnea and respiratory depression 5

Common Adverse Effects to Monitor

• Somnolence, fatigue, and sedation (most common) 1
• Bradycardia and hypotension 1, 6
• Dry mouth and irritability 1
• Sedative effects may persist into the following day, potentially affecting school performance 1

Monitoring Requirements

• Obtain complete medical history of patient and first-degree family members before starting, specifically screening for sudden death, repeated fainting, or arrhythmias 1
• Monitor blood pressure and heart rate regularly 1, 7
• Regular follow-up visits are essential to assess efficacy and side effects 1

Critical Warnings

Discontinuation Protocol

• Never abruptly discontinue clonidine - this can cause severe rebound hypertension and hypertensive crisis 7, 3
• Must be tapered gradually, though specific tapering protocols are not well-established in the literature 6

Dosing Administration Pitfalls

• Compounding and liquid dosing errors are common in children and may result in massive overdoses 8
• Particular care is needed with extemporaneously compounded liquid formulations 8
• If using transdermal patches, avoid cutting patches as this results in variable and significantly higher serum concentrations 6

Onset of Effects and Observation Period

• Full clinical effects (including toxicity) develop within 4 hours of ingestion 4
• Peak plasma concentrations occur at approximately 2 hours after oral administration 9
• Observation for 4 hours may be sufficient to detect patients who will develop severe effects 4