From the Guidelines
Clonidine dosing should be initiated at 0.1 mg orally twice daily, with a usual dose range of 0.1-0.8 mg per day divided into 2 doses, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The dosing of clonidine can vary depending on the specific condition being treated, but for hypertension, the dose range is typically between 0.1-0.8 mg per day.
- Key considerations for clonidine dosing include:
- Starting dose: 0.1 mg orally twice daily
- Usual dose range: 0.1-0.8 mg per day divided into 2 doses
- Maximum daily dose: not explicitly stated in the guideline, but typically not exceeding 1.2 mg daily in other contexts
- It is essential to monitor blood pressure regularly, especially when initiating therapy or adjusting doses, and to avoid abrupt discontinuation, which can cause rebound hypertension; instead, the medication should be tapered gradually over 2-4 days when discontinuing, as noted in the guideline 1.
- Common side effects of clonidine include dry mouth, drowsiness, dizziness, and constipation, and the medication is generally reserved as a last-line treatment due to significant CNS adverse effects, especially in older adults 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults The dose of clonidine hydrochloride tablets, USP must be adjusted according to the patient’s individual blood pressure response. The following is a general guide to its administration. Initial Dose 0.1 mg tablet twice daily (morning and bedtime). Maintenance Dose Further increments of 0. 1 mg per day may be made at weekly intervals if necessary until the desired response is achieved. The therapeutic doses most commonly employed have ranged from 0.2 mg to 0.6 mg per day given in divided doses. Studies have indicated that 2. 4 mg is the maximum effective daily dose, but doses as high as this have rarely been employed.
The initial dose of clonidine is 0.1 mg twice daily. The maintenance dose can be increased by 0.1 mg per day at weekly intervals, with therapeutic doses commonly ranging from 0.2 mg to 0.6 mg per day. The maximum effective daily dose is 2.4 mg 2.
- Key points:
- Initial dose: 0.1 mg twice daily
- Maintenance dose: increase by 0.1 mg per day at weekly intervals
- Therapeutic dose range: 0.2 mg to 0.6 mg per day
- Maximum effective daily dose: 2.4 mg
From the Research
Clonidine Dose Information
- The dose of clonidine required to achieve acceptable blood pressure control can vary between patients, with an average dose of 0.45 mg required in one study 3.
- Clonidine can be administered in different dosage schedules, including twice daily, thrice daily, or once daily, with twice daily administration resulting in better control of blood pressure in some patients 4.
- The dose of clonidine can range from 0.05 mg twice daily to 0.2 mg three times daily for monotherapy in elderly patients with mild essential hypertension 5.
- In combination with a diuretic, clonidine can be administered at a dose of 0.1 mg to 0.3 mg twice daily to achieve blood pressure control 5.
- Oral clonidine loading with an initial dose of 0.2 mg, followed by 0.1 mg each hour until a dose of 0.7 mg has been given or a diastolic blood pressure goal is reached, can be effective in managing hypertensive urgencies 3.
Side Effects and Tolerability
- Common side effects of clonidine include dry mouth, somnolence, and nonsyncopal dizziness, with somnolence being more frequent in patients treated with clonidine compared to guanfacine 6.
- Sedation, a common side effect of clonidine, appears to be mediated by central alpha 2-adrenergic receptors 7.
- Clonidine can be well-tolerated in elderly patients, with side effects not requiring discontinuation of therapy in one study 5.