Clonidine Adult Dosing
For hypertension management in adults, start clonidine at 0.1 mg twice daily (morning and bedtime), then titrate upward by 0.1 mg per day at weekly intervals as needed, with typical therapeutic doses ranging from 0.2-0.6 mg daily in divided doses and a maximum effective dose of 2.4 mg daily. 1
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 Strategy
- Increase by 0.1 mg per day at weekly intervals until blood pressure goals are achieved 1
- Taking the larger portion of the daily dose at bedtime minimizes daytime sedation and dry mouth 1, 2
- Monitor blood pressure and heart rate after each dose adjustment 3
Therapeutic Dose Range
- Most patients achieve adequate control on 0.2-0.6 mg daily in divided doses 1, 3
- The maximum effective daily dose is 2.4 mg, though doses this high are rarely necessary 1, 3
- Twice-daily dosing with a larger bedtime dose provides superior blood pressure control while limiting daytime drowsiness compared to once-daily or three-times-daily regimens 2
Alternative Formulations
- Transdermal patches (0.1-0.3 mg) can be applied once weekly for patients who prefer or require non-oral administration 3
Critical Safety Warning
Abrupt discontinuation must be avoided—clonidine causes severe rebound hypertension and hypertensive crisis when stopped suddenly, requiring gradual tapering when discontinuing therapy. 3, 4
Common Pitfalls
- Sedation and dry mouth are dose-related and typically diminish with continued use; these can be minimized by gradual dose escalation and bedtime-weighted dosing 1, 5
- Orthostatic hypotension is particularly concerning in older adults and requires monitoring 3
- Hemodialysis does not significantly remove clonidine, so no supplemental dosing is needed post-dialysis 1