Average Dose for Catapres (Clonidine)
For hypertension in adults, the average maintenance dose of clonidine is 0.2-0.8 mg per day in divided doses, typically given twice daily. 1
Dosing by Clinical Indication
Hypertension (Most Common Use)
- Initial dose: Start with 0.1 mg twice daily (0.2 mg total daily dose) 1
- Average maintenance dose: 0.2-0.8 mg per day in 2 divided doses 1
- Titration: Increase gradually based on blood pressure response 1
- The ACC/AHA guidelines position clonidine as a later-line agent due to significant CNS adverse effects, particularly in older adults 1
Hypertensive Urgencies/Emergencies (Rapid Titration Protocol)
When rapid blood pressure control is needed, a specific loading protocol exists:
- Initial loading dose: 0.1-0.2 mg orally 2, 3, 4
- Subsequent doses: 0.05-0.1 mg hourly until goal blood pressure achieved 2, 3
- Maximum total dose: 0.7-0.8 mg during titration period 3, 4
- Average effective dose: 0.32-0.5 mg achieves blood pressure control in 82-93% of patients within 1.8-6 hours 2, 4
PTSD-Associated Nightmares
- Initial dose: 0.2 mg at bedtime 1
- Average effective dose: 0.2-0.6 mg in divided doses 1
- The evidence for this indication is limited (Level C recommendation), with only case series from refugee populations available 1
Pediatric Dosing (ADHD/Behavioral Symptoms)
- Initial dose: 0.05-0.1 mg at bedtime 5
- Maximum dose: 0.4 mg per day 5
- The American Academy of Child and Adolescent Psychiatry recommends starting low and titrating gradually 5
Critical Safety Warnings
Discontinuation Protocol
Never abruptly discontinue clonidine—this can precipitate severe rebound hypertension and hypertensive crisis. 1, 5
- Clonidine must be tapered gradually to avoid rebound hypertension 1
- The ACC/AHA specifically warns about this life-threatening complication 1
Monitoring Requirements
- Monitor blood pressure and heart rate regularly due to risks of bradycardia and hypotension 5
- Screen for history of sudden death, syncope, or arrhythmias in patient and first-degree relatives before initiating 5
- Watch for orthostatic hypotension, especially in older adults 1
Common Adverse Effects
- Drowsiness, sedation, and fatigue (most common) 5, 6
- Dry mouth 5, 6
- CNS effects that may be particularly problematic in elderly patients 1
- At low doses (75-150 mcg daily for migraine), these effects tend to diminish with continued treatment 6
Special Populations
- Elderly patients: Consider lower initial doses due to increased CNS sensitivity 1, 5
- Renal impairment: Use lower initial doses with careful monitoring; no supplemental dosing needed after hemodialysis 5
- Pregnancy: Maximum dose 1.2 mg per day in third trimester for hypertension 5
Formulation Considerations
The transdermal patch formulation delivers 0.1-0.3 mg weekly, providing an alternative to oral dosing for maintenance therapy 1