What is a recommended taper schedule for an adult patient with hypertension taking Clonidine (clonidine) 0.2mg?

Clonidine Taper Schedule for 0.2mg Daily Dose

When discontinuing clonidine 0.2mg daily for hypertension, reduce the dose gradually over 2 to 4 days to prevent potentially life-threatening rebound hypertension, as mandated by the FDA label. 1

Critical Safety Warning

Abrupt discontinuation of clonidine can cause severe rebound hypertension with nervousness, agitation, headache, tremor, rapid blood pressure elevation, and elevated plasma catecholamines. 1 Rare cases have resulted in hypertensive encephalopathy, cerebrovascular accidents, and death. 1

Recommended Taper Protocol

For a patient on clonidine 0.2mg daily, use one of these FDA-approved approaches:

Option 1: 4-Day Taper (Preferred for Safety)

• Day 1-2: Reduce to 0.15mg daily 1
• Day 3-4: Reduce to 0.1mg daily 1
• Day 5-6: Reduce to 0.05mg daily 1
• Day 7: Discontinue 1

Option 2: 2-Day Taper (Minimum Duration)

• Day 1: Reduce to 0.1mg daily 1
• Day 2: Reduce to 0.05mg daily 1
• Day 3: Discontinue 1

Special Precautions During Taper

If the patient is concurrently taking a beta-blocker, withdraw the beta-blocker several days BEFORE beginning the clonidine taper. 1 The combination significantly increases the risk of severe rebound hypertension. 1

Monitor blood pressure closely during and for 48-72 hours after completing the taper. 1 Patients should be instructed to report symptoms of nervousness, agitation, headache, or tremor immediately. 1

Management of Rebound Hypertension

If excessive blood pressure elevation occurs during or after tapering:

• Restart oral clonidine immediately 1
• Alternatively, administer intravenous phentolamine 1
• Do not attempt to continue the taper until blood pressure is stable 1

Important Clinical Context

Clonidine is not a first-line agent for hypertension and is typically reserved for resistant hypertension after failure of ACE inhibitors/ARBs, calcium channel blockers, thiazide diuretics, and spironolactone. 2 The ACC/AHA guidelines do not list clonidine as a preferred agent for hypertensive emergencies. 2

Children are particularly susceptible to rebound hypertension if they develop vomiting or gastrointestinal illness that prevents them from taking clonidine. 1 This population requires especially careful monitoring during any taper. 1

Common Pitfall to Avoid

Never allow a patient to simply stop clonidine without a structured taper, even if switching to another antihypertensive. 1 The new medication should be started and titrated to effect while clonidine is still being taken, then clonidine should be tapered as described above. 1