Maximum Dose of Clonidine
The maximum recommended dose of clonidine for hypertension is 2.4 mg per day in divided doses, though doses above 0.8 mg per day are rarely employed in clinical practice. 1
Hypertension Management
Standard Dosing Parameters
- Typical therapeutic range: 0.2-0.6 mg per day in divided doses (oral tablets twice daily or transdermal patch weekly) 2
- FDA-approved maximum: 2.4 mg per day, though this represents the ceiling beyond which no additional efficacy is observed 1
- Practical maximum: 0.8 mg per day for most clinical scenarios, as higher doses rarely provide additional benefit and increase adverse effects 2
Acute Hypertensive Crisis (Loading Protocol)
- Initial loading dose: 0.1-0.2 mg orally, followed by 0.05-0.1 mg hourly 3, 4
- Maximum acute loading dose: 0.7-0.8 mg total within the first 6-8 hours 3, 4, 5
- This rapid titration protocol achieves blood pressure control in 82-93% of patients with hypertensive urgencies 3, 4
ADHD Management
Pediatric Dosing
- Maximum recommended: 0.4 mg per day for ADHD treatment in children and adolescents 2
- Starting dose: 0.1 mg at bedtime, with careful uptitration to twice-daily dosing 2
- Doses exceeding 0.4 mg/day are explicitly not recommended for ADHD 2
Critical Safety Considerations
Rebound Hypertension Risk
- Never abruptly discontinue clonidine - this causes life-threatening rebound hypertensive crisis within 24-36 hours 2, 6, 7
- Mandatory taper: reduce by 33% every 2 days over at least 4-8 days when discontinuing 6
- Start alternative antihypertensive agents at the beginning of the taper, not after discontinuation 6
Cardiovascular Monitoring Thresholds
- Hold dose if heart rate <50 bpm or symptomatic bradycardia develops 8, 7
- Hold dose if systolic BP <100 mmHg or symptomatic hypotension occurs 7
- Monitor closely for orthostatic hypotension, especially in elderly patients 2
Common Adverse Effects
- Most frequent: sedation (28% initially, 11.7% long-term), dry mouth (35% initially, 26.6% long-term) 9
- Constipation, dizziness, and syncope also reported 2
- Most side effects diminish after the first month of therapy 9
Special Populations
Renal Impairment
- Lower initial doses required in patients with kidney disease 1
- No supplemental dosing needed after hemodialysis (minimal drug removal) 1
Elderly Patients
- Start with lower initial doses (0.05-0.1 mg) due to increased sensitivity 1
- Higher risk of orthostatic hypotension and CNS effects 2
Common Pitfalls to Avoid
- Do not use clonidine as first-line therapy - it is reserved as last-line due to significant CNS adverse effects, particularly in older adults 2
- Do not exceed 0.8 mg in acute loading protocols without intensive monitoring, as one death from cerebral infarct was reported with rapid titration 5
- Do not discharge patients on clonidine without explicit tapering instructions and close follow-up within 24 hours if used for acute management 3
- Avoid in patients with baroreceptor dysfunction - paradoxical severe hypotension can occur 10