Is clonidine (antihypertensive medication) 0.1 mg used for insomnia?

Clonidine 0.1 mg for Insomnia

Clonidine 0.1 mg is not FDA-approved for insomnia and should not be used as a primary sleep aid, though it may be considered in specific clinical contexts where insomnia is secondary to other conditions like ADHD or menopausal symptoms. 1

Primary Indication and Off-Label Use

• Clonidine is FDA-approved exclusively as an antihypertensive agent, with typical dosing of 0.1-0.8 mg daily in divided doses for blood pressure control 1, 2
• The American College of Cardiology explicitly categorizes clonidine as a "last-line" antihypertensive due to significant CNS adverse effects, particularly in older adults 1
• Paradoxically, insomnia is listed as a common side effect of clonidine, not a therapeutic benefit 1

Evidence for Sleep-Related Uses

ADHD-Associated Sleep Disturbances

• The American Academy of Child and Adolescent Psychiatry recognizes clonidine's use for ADHD-related insomnia, particularly when stimulants cause or worsen sleep problems 1
• Starting dose is 0.05 mg at bedtime, never exceeding 0.3 mg/day, with slow titration 1
• One systematic chart review (N=62) showed 85% of children/adolescents with ADHD-related sleep disturbances improved with clonidine (mean dose 157 mcg at night), though this was retrospective and uncontrolled 3

Menopausal Night Sweats

• For night sweats specifically, the American Academy of Sleep Medicine suggests 0.1-0.2 mg at bedtime may have efficacy 4
• However, the Annals of Oncology guidelines note that 40% of patients discontinued clonidine due to side effects (including both insomnia AND drowsiness), compared to only 10-20% for SSRIs/SNRIs and 10% for gabapentin 1
• Clonidine reduced hot flashes by up to 46%, but this is inferior to gabapentin and comparable to SSRIs 1

PTSD-Related Sleep Disturbances

• A 2024 systematic review found only very low to low quality evidence for clonidine in PTSD-related sleep problems 5
• Prazosin has Level A evidence for PTSD nightmares, while clonidine has only Level C evidence 4

Critical Safety Concerns

The most important clinical pitfall is abrupt discontinuation:

• The ACC/AHA explicitly warns that stopping clonidine suddenly can cause severe rebound hypertension and hypertensive crisis 1, 2, 4
• Clonidine must be tapered gradually, even when used at low doses for non-hypertensive indications 1, 2

Additional safety issues:

• Bradycardia and hypotension occur at rates less than 1/100 but require monitoring 1
• Elderly patients have increased CNS sensitivity and require lower initial doses 2
• The medication causes both drowsiness AND insomnia as side effects, making response unpredictable 1

Clinical Algorithm

For primary insomnia: Do not use clonidine. Consider evidence-based treatments like CBT-I, melatonin, or FDA-approved hypnotics.

For ADHD-related insomnia in children/adolescents:

• Start 0.05 mg at bedtime 1
• Titrate slowly, maximum 0.3 mg/day 1
• Monitor blood pressure and heart rate 1
• Ensure family history excludes sudden death, arrhythmias, or repeated fainting 1

For menopausal night sweats:

• Consider SSRIs/SNRIs or gabapentin first-line due to better tolerability 1
• If using clonidine: 0.1 mg daily (oral or transdermal) 1
• Expect 40% discontinuation rate due to side effects 1

For PTSD-related nightmares/sleep disturbances:

• Use prazosin first-line (Level A evidence) 4
• Clonidine only if prazosin fails or is contraindicated 4