Maximum Daily Dose of Clonidine
The maximum recommended daily dose of clonidine is 2.4 mg per day for hypertension, though doses above 0.6 mg daily are rarely employed in clinical practice. 1
FDA-Approved Maximum Dosing
The FDA label clearly establishes that 2.4 mg is the maximum effective daily dose for clonidine tablets, though it notes that doses this high have rarely been employed in practice. 1 The therapeutic doses most commonly used range from 0.2 mg to 0.6 mg per day given in divided doses. 1
Context-Specific Maximum Doses
The maximum dose varies significantly depending on the clinical indication:
For Hypertension (Primary Indication)
- Standard maintenance range: 0.2-0.6 mg per day in divided doses 1
- Absolute maximum: 2.4 mg per day 1
- Initial dosing: 0.1 mg twice daily (morning and bedtime), with increments of 0.1 mg per day at weekly intervals 1
For ADHD Treatment
- Maximum in children: 0.4 mg per day 2, 3, 4
- Initial pediatric dose: 0.05-0.1 mg at bedtime, titrated gradually 4
- Extended-release clonidine for ADHD in Korea has a maximum of 0.4 mg daily 2
For Anxiety and PTSD
- Maximum for anxiety: 0.4 mg per day divided into 2-3 doses 3
- For PTSD-associated nightmares: 0.2-0.6 mg in divided doses 3
For Hypertensive Emergencies (Acute Loading)
- Maximum loading dose: 0.7-0.8 mg total over several hours 5, 6
- Protocol: 0.1-0.2 mg initial dose, followed by 0.05-0.1 mg hourly until goal BP achieved or maximum reached 5
- This acute dosing achieves blood pressure reduction in 93% of patients 5
Critical Safety Considerations
Rebound Hypertension Risk
Never abruptly discontinue clonidine as this can cause severe rebound hypertension and hypertensive crisis; the medication must be tapered gradually. 3, 4 This is one of the most dangerous complications and occurs regardless of the dose being used.
Monitoring Requirements
- Monitor blood pressure and heart rate regularly due to risks of bradycardia and hypotension 4
- Common adverse effects include somnolence, fatigue, sedation, dry mouth, and orthostatic hypotension 3
- Obtain complete medical history screening for sudden death, fainting, or arrhythmias before initiating therapy 4
Special Populations
- Elderly patients: May benefit from lower initial doses 1
- Renal impairment: Patients benefit from lower initial doses with careful monitoring; no supplemental dosing needed after hemodialysis 1
- Pregnancy: Maximum 1.2 mg per day for hypertension in third trimester 2
Practical Dosing Strategy
Taking the larger portion of the daily dose at bedtime minimizes transient side effects of dry mouth and drowsiness. 1 For twice-daily dosing, administering a larger dose at bedtime and smaller dose before noon can limit daytime drowsiness while maintaining blood pressure control. 7