Clonidine
CATAPRES
Pronunciation: KLOE-ni-deen
“Clown dines, Cat impressed”
orange plus signs → alpha-2 agonist
What it isAlpha-2 and imidazoline agonist that reduces sympathetic outflow; hypertension, ADHD and withdrawal states.
Why this oneIts central sympatholysis makes it unusually useful for ADHD, tics and autonomic withdrawal symptoms as well as hypertension.
What limits itAbrupt withdrawal can cause severe rebound hypertension. Sedation, dry mouth and bradycardia limit use; patches have delayed onset and offset.
FDA-approved for
- hypertension (1974)
- ADHD (ER) (2010)
Off-label
- tics
- opioid/nicotine withdrawal
- menopausal flushing
- anesthetic adjunct
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adult | 0.1 mg BID (AM & QHS) | 0.2-0.6 mg/day divided | 2.4 mg/day |
Titration Increase by 0.1 mg/day at weekly intervals
Renal Lower initial dose and monitor closely; no supplemental dose needed after hemodialysis (minimal removal)
Hepatic Undefined
Instructions
- Take the larger portion of the daily dose at bedtime to minimize dry mouth and drowsiness
- Elderly or renally impaired patients: use a lower initial dose
Available strengths
- tab 0.1, 0.2, 0.3 mg
Cautions
- Withdrawal/rebound hypertension if discontinued abruptly
- Bradycardia and AV block (with and without concomitant digitalis)
- Sedation and drowsiness
- Orthostatic symptoms
- Increased sensitivity to alcohol
Adverse reactions
- Dry mouth (~40%)
- Drowsiness (~33%)
- Dizziness (~16%)
- Constipation (~10%)
- Sedation (~10%)
- Fatigue/weakness
Pregnancy Pregnancy Category C; crosses the placental barrier; use only if clearly needed
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 0.1 mg | tab | 60 BID | $1.45 | offered |
| 0.2 mg | tab | 60 BID | $1.98 | offered |
| 0.3 mg | tab | 60 BID | $2.45 | offered |
Other forms: Clonidine ER suspension (ONYDA XR)
Generic entry2009
NO BOXED WARNINGS
Principal riskRebound hypertension on abrupt withdrawal
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
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