Clonidine Dosing Recommendations
For routine hypertension management in adults, start clonidine at 0.1 mg twice daily (morning and bedtime), then increase by 0.1 mg per day at weekly intervals as needed, with typical maintenance doses ranging from 0.2-0.6 mg daily in divided doses. 1
Standard Adult Dosing for Chronic Hypertension
Initial Dosing
- Begin with 0.1 mg twice daily (morning and bedtime administration) 1
- Elderly patients should receive a lower initial dose due to increased sensitivity 1
- Patients with renal impairment require a lower starting dose with careful monitoring 1
Titration Schedule
- Increase by 0.1 mg per day at weekly intervals until blood pressure control is achieved 1
- Taking the larger portion of the daily dose at bedtime minimizes side effects like dry mouth and drowsiness 1
Maintenance Dosing
- Therapeutic doses typically range from 0.2-0.6 mg daily in divided doses 1
- Maximum effective daily dose is 2.4 mg, though doses this high are rarely needed 1
Hypertensive Urgencies/Emergencies (Rapid Oral Loading)
Loading Protocol
- Initial dose: 0.1-0.2 mg orally 2, 3
- Follow with 0.05-0.1 mg hourly until goal blood pressure is reached or maximum total dose of 0.7-0.8 mg is administered 2, 3
- This achieves significant blood pressure reduction in 93% of patients 2
- Average effective dose is 0.32-0.5 mg with response time of 1.8-5 hours 4, 5, 3
Important Caveats for Rapid Loading
- Use only in carefully selected patients, particularly avoiding those with symptomatic arteriosclerotic disease 4
- Mandatory 24-hour outpatient follow-up is required for non-hospitalized patients 2
- Monitor for excessive blood pressure reduction that could compromise organ perfusion 2
Critical Safety Warning
Never abruptly discontinue clonidine once a patient is established on it—always taper to avoid rebound hypertension and potential hypertensive crisis. 6 This is a central alpha-2 agonist that suppresses sympathetic outflow, and sudden cessation can cause dangerous rebound effects 6.
Special Populations
Renal Impairment
- Lower initial doses are necessary 1
- No supplemental dosing needed after hemodialysis (minimal removal during dialysis) 1