What is the dosing regimen for Clonidine (Arkamin)?

Clonidine (Arkamin) Dosing Regimen

For hypertension, 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 per day in divided doses. 1

Standard Oral Dosing for Hypertension

Initial Dosing

• Start with 0.1 mg twice daily (morning and bedtime) 1
• Elderly patients should receive a lower initial dose 1
• Patients with renal impairment benefit from a lower initial dose and require careful monitoring 1

Dose Titration

• Increase by 0.1 mg per day at weekly intervals until desired blood pressure response is achieved 1
• Taking the larger portion of the daily dose at bedtime minimizes transient side effects like dry mouth and drowsiness 1

Maintenance Dosing

• Typical therapeutic range: 0.2-0.6 mg per day in divided doses 1
• Maximum effective daily dose is 2.4 mg, though doses this high are rarely employed 1
• Hemodialysis patients do not require supplemental dosing post-dialysis as minimal clonidine is removed 1

Alternative Formulations

Transdermal Patch

• Dose range: 0.1-0.3 mg applied once weekly 2
• Provides steady-state drug delivery with less peak-to-trough fluctuation than oral dosing 3
• Maximum blood pressure reduction occurs 2-3 days after initial application and is maintained for at least 7 days 3

Rapid Titration for Hypertensive Urgencies

For severe hypertension requiring rapid control:

• Initial dose: 0.1-0.2 mg orally 4
• Follow with 0.05-0.1 mg hourly until goal blood pressure is achieved or total dose of 0.7-0.8 mg is reached 5, 4
• This achieves significant blood pressure reduction in 93% of patients 4
• Mean response time is approximately 1.8 hours with mean dose of 0.32 mg 5

Special Indications

ADHD (Off-Label)

• Starting dose: 0.05-0.1 mg orally at bedtime 6
• Use only as an adjunct agent following risk-benefit discussion 6
• Twice-daily dosing is typically necessary for ADHD management 2

Menopausal Hot Flashes

• Typical dose: 0.1 mg per day (oral or transdermal) 6
• Can reduce hot flashes by up to 46% 6

Critical Safety Warnings

Discontinuation Protocol

• Never abruptly discontinue clonidine - this may induce hypertensive crisis 2, 6
• Always taper gradually to avoid rebound hypertension 2, 6

Monitoring Parameters

• Pulse and blood pressure should be monitored regularly 2
• Breastfeeding infants require monitoring for drowsiness and hypotonia 6

Common Adverse Effects

• Sedation/drowsiness, dry mouth, fatigue, hypotension, and irritability are frequent 2
• Significant CNS adverse effects make clonidine generally reserved as a last-line agent, especially in older adults 2, 6
• Orthostatic hypotension is common, particularly in elderly patients 6

Drug Positioning

• Clonidine is not recommended as a first-line antihypertensive agent due to its adverse effect profile 2
• Consider as first-line option only in specific comorbidities: sleep disorders, substance use disorders, disruptive behavior disorders, or tic/Tourette's disorder 2