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Clonidine

Medical and Pharmacy Editor:

Brand Name: Catapres, Catapres-TTS, Duraclon, Jenloga, Kapvay

Generic Name: Clonidine

Drug Class: Central Alpha2 Agonists; ADHD Agents

What Is Clonidine and How Does It Work?

Clonidine is a prescription medication that is used alone or with other medications to treat high blood pressure, to lower blood pressure to help prevent strokes, heart attacks and kidney problems. Clonidine belongs to a class of drugs (central alpha agonists) that act in the brain to lower blood pressure. It works by relaxing blood vessels so blood can flow more easily.

Clonidine is available under the following different brand names: Catapres, Catapres-TTS, Duraclon, Jenloga, and Kapvay.

Dosages of Clonidine:

Adult and pediatric dosages

Injectable solution

  • 100 mcg/ml
  • 500 mcg/ml

Patch, extended-release

  • 0.1 mg/day
  • 0.2 mg/day
  • 0.3 mg/day

Tablet, immediate-release

  • 0.1 mg
  • 0.2 mg
  • 0.3 mg

Tablet, extended-release

  • 0.1 mg

Dosage Considerations – Should be Given as Follows:

Hypertension

Immediate-release tablet

  • 0.1 mg orally every 12 hours
  • Range: 0.1-0.2 mg/day every 12 hours, not to exceed 2.4 mg/day

Transdermal Patch

  • Apply 1 patch every 7 days, start with 0.1 mg; increase by 0.1 mg after every 1-2 week interval; usual dose range is 0.1-0.3 mg each week

Children older than 12 years

Immediate-release tablets

  • 0.2 mg/day orally divided every 12 hours; increase each week; maintenance dose range, 0.2-0.6 mg/day every 12 hours; not to exceed 2.4 mg/day

Transdermal patch

  • 0.1 mg patch every 7 day initially; may increase by weekly 0.1-mg increments after 1-2 weeks if desired blood pressure reduction not achieved; not to exceed 0.6 mg/week (2 clonidine 0.3 mg patches)

Children under 12 years old

  • Immediate-release tablets and transdermal patch: Safety and efficacy not established

Geriatric

  • immediate-release tablets: 0.1 mg orally at bedtime

Geriatric dosing considerations

Cancer Pain

Epidural infusion

Severe pain in patients with cancer not adequately relieved by opioid analgesics alone

Initial

  • 30 mcg/hr, adjust dose as required for pain relief or presence of side effects
  • Limited data on doses exceeding 40 mcg/hr

Epidural infusion considered as adjunct to intraspinal opiate therapy; epidural administration (Duraclon) is indicated in combination with opiates for the treatment of severe pain in patients with cancer not adequately relieved by opioid analgesics alone.

More likely to be effective in patients with neuropathic pain than in those with somatic or visceral pain.

Pediatric epidural infusion: 0.5 mcg/kg/hr initially; adjust according to clinical response.

Epidural administration (Duraclon) is indicated in combination with opiates for the treatment of severe pain in patients with cancer not adequately relieved by opioid analgesics alone. Restrict use to pediatric patients with severe, intractable pain from malignancy that is unresponsive to epidural or spinal opiates or to other, more conventional analgesic techniques. More likely to be effective in patients with neuropathic pain than in those with somatic or visceral pain. Safety and effectiveness of epidural administration in this limited indication and clinical population have been established in patients old enough to tolerate placement and management of an epidural catheter; these conclusions are based on evidence from adequate and well-controlled studies in adults and through experience with the use of clonidine in the pediatric age group for other indications.

Acute Hypertension (Off-label)

  • 0.1-0.2 mg orally, may follow with additional doses of 0.1 mg every hour as needed to maximum 0.6 mg total dose

ETOH Withdrawal (Off-label)

  • 0.3-0.6 mg orally every 6 hours

Smoking Cessation (Off-label)

Oral administration

  • 0.1 mg each day; increase by 0.1 mg/day to 0.15-0.75 mg/day if required

Transdermal administration

  • 100-200 mcg/day patch every 7 days
  • 0.3-0.6 mg orally every 6 hours

Restless Legs Syndrome (Off-label)

  • 100-300 mcg orally every 2 hours before bedtime, up to 900 mcg/day

Tourette's Syndrome (Off-label)

  • 0.0025-0.015 mg/kg/day orally for 6 weeks to 3 months

Cyclosporine Nephrotoxicity (Off-label)

  • 100-200 mcg/day transdermal patch; change every 7 days

Menopausal Flushing (Off-label)

  • Apply 100 mcg/day patch; change every 7 days, OR
  • 50 mcg orally every 12 hours initially; may increase up to 400 mcg every 12 hours

Dysmenorrhea (Off-label)

Oral administration

Opioid Withdrawal (Off-label)

Oral administration

  • 0.1-0.3 mg every 4-6 hours, increase by 0.1 mg/day to 0.15-0.75 mg/day if required; do not exceed 2.4 mg/day

Transdermal administration

  • 100-200 mcg/day patch every 7 days initiate 0.1-0.3 mg orally every 4-6 hours for first 2 days to allow for adequate drug levels

Postherpetic Neuralgia (Off-label)

Oral administration

  • 0.1 mg every 12 hours

Psychosis (Off-label)

Oral administration

  • 0.4-1.4 mg/day in divided doses

Pheochromocytoma Diagnosis (Off-label)

Clonidine suppression testing

  • 0.3 mg orally for 60-80 kg patient; obtain blood sample 3 hours after administration to supine patient

Dosing Considerations

Extended-release is not to be used interchangeably with immediate-release tablets.

Conversion from oral to transdermal

  • Day 1: Place Catapress-TTS-1; administer 100% of oral dose
  • Day 2: Administer 50% of oral dose
  • Day 3: Administer 25% of oral dose
  • Day 4: Patch remains, no further oral supplement needed

ADHD, Pediatric

Children under 6 years old: Not established

Children 6 years or older: (extended-release tablets, Kapvay): 0.1 mg orally at bedtime initially; may adjust dose by increments of 0.1 mg/day at weekly intervals until desired response; not to exceed 0.4 mg/day.

When discontinuing, taper gradually by decrements not to exceed 0.1 mg every 3-7 days.

Dosing considerations

May be given as monotherapy or as adjunctive therapy with stimulants. Extended-release not interchangeable with immediate-release product.

Doses 0.2 mg/day or greater should be divided twice a day, with either an equal or higher split dosage being given at bedtime. Swallow tablet whole; do not crush, chew, or split.

Dosing Modifications

Renal Impairment

Impact of renal impairment not assessed

Initial dose should be based on amount of renal impairment

Monitor carefully for low blood pressure and lower heart rate.

Removed minimally during hemodialysis; no need to re-dose following dialysis

Geriatric: immediate release: Lower initial doses than for non-geriatric adult dosing, as well as gradual adjustments, are recommended.

Extended release: May require lower initial dose than for non-geriatric adult dosing.

Medically Reviewed by a Doctor on 4/14/2017



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