Clonidine

Photo by: Sean M

Definition

Clonidine belongs to a class of drugs called central alpha-adrenergic agonists. In the United States, clonidine tablets are sold under the brand name Catapres and clonidine skin patches are sold under the brand name Catapres-TTS. The tablets are also available generically. There is also an injectable form that is administered directly into the spinal cord for the treatment of postoperative pain.

Purpose

Clonidine tablets and patches are approved by the United States Food and Drug Administration (FDA) for the treatment of high blood pressure. However, clonidine has been found to be useful in the treatment of alcohol, opiate, and nicotine withdrawal syndromes, attention-deficit/hyperactivity disorder (ADHD), and Tourette's syndrome, one of the tic disorders .

Description

Clonidine was synthesized in 1960s and was initially tested as a nasal decongestant. In the United States, clonidine was first used to treat hypertension although it has also been investigated for treatment of different neuropsychiatric disorders. Clonidine works on specific nerve cells in the brain that are responsible for lowering blood pressure, slowing heart rate, and decreasing the body's reaction to the withdrawal of chemicals like alcohol, opiates, cocaine, and nicotine. Because of this, clonidine is often used to treat the symptoms of drug, alcohol, and nicotine withdrawal.

Clonidine is beneficial in opiate withdrawal because it treats symptoms that are commonly associated with that condition (watery eyes and nose, diarrhea, irritability). For this condition, clonidine is often used alone. For the treatment of alcohol withdrawal, clonidine is usually combined with benzodiazepine tranquilizers such as Librium, Valium, Xanax, or Ativan.

Several studies of treatment for smoking cessation showed patients treated with clonidine had decreased nicotine craving. Clonidine skin patches appear to be more effective than tablets in this condition. Both dermal patches and tablets are effective in the treatment of Tourette's syndrome and ADHD.

Clonidine tablets are available in 0.1-mg, 0.2-mg, and 0.3-mg strengths. Clonidine skin patches are available in 0.1-mg, 0.2-mg, and 0.3-mg per day patches. Each patch lasts seven days.

Recommended dosage

Dosages of 0.4–0.6 mg have been used for the treatment of alcohol withdrawal. Total daily dosage for the treatment of opiate withdrawal range between 0.5 and 1.4 mg, depending on the stage as well as the severity of withdrawal symptoms. If the clonidine patch is used to treat nicotine withdrawal symptoms, dosages that deliver 0.1–.2 mg daily are used. For oral therapy (tablets), a total dosage of 0.2–0.4 mg daily is taken in divided doses.

Pediatric doses of clonidine are calculated based on the child's body weight. Clonidine dosage for ADHD in children is 5 micrograms per kilogram of body weight per day orally in four divided doses. Children who require a daily dosage of 0.2 mg usually can use the 0.3 mg dermal patch. If ADHD is associated with sleep disturbances, low to moderate doses of clonidine can be taken at bedtime. Oral doses in children with Tourette's syndrome range from 3 to 6 micrograms per kilogram of body weight per day divided into two to four even doses.

Precautions

Clonidine should not be used by people who have a known allergy to this drug. If a person has underlying depression, clonidine should be used with caution and under close physician supervision.

Clonidine should not be abruptly withdrawn but rather, slowly decreased over several days to avoid withdrawal symptoms. Withdrawal symptoms include increases in blood pressure, irritability, nervousness, insomnia , and headache. Because of the possibility of withdrawal, clonidine should not be used in patients who are unwilling or unable to follow the prescribing information.

Clonidine should be used only with caution and close physician supervision in patients with chronic renal failure, coronary artery disease, and in patients with preexisting eye problems. Often people with kidney disease should take a reduced dosage. Clonidine should not be used by pregnant women, except in the rare case where the benefits of taking clonidine outweigh the risks to the developing fetus.

Side effects

The most common side effect associated with clonidine is dizziness associated with sudden changes in position such as standing up rapidly. In order to avoid this, atients should stand up slowly. People using the dermal patch may develop rash, hair loss, a burning sensation on the skin, or other skin irritations where the patch is applied. Switching to tablets may not completely eliminate these skin problems, however.

Clonidine can cause dry mouth, constipation, nausea, daytime sleepiness, weakness, and lethargy. These side effects may take several weeks to disappear. In some cases, these side effects can be eliminated with dosage readjustment. In addition, clonidine may cause eye dryness, loss of sex drive, and decreased sexual activity.

If patients experience weight gain in the beginning of therapy, they can expect this side effect to decline over a period of several days to weeks.

Interactions

Clonidine's blood pressure-lowering effects may be enhanced by other drugs that lower blood pressure. Conversely, the blood pressure-lowering effects of clonidine may be negated by many antidepressants.

Resources

BOOKS

Kaplan, Harold. Comprehensive Textbook of Psychiatry. Williams and Wilkins, 1995.

Lacy, Charles F. Drug Information Handbook. Lexi-Comp, Inc. 2002.

PERIODICALS

Kellner, Michael. "Influence of Clonidine on Psychopathological, Endocrine and Respiratory Effects of Cholecystokinin Tetrapeptide In Patients With Panic Disorder." Psychopharmacology. 133 (1997): 55-61.

Ajna Hamidovic, Pharm.D.

User Contributions:

Denise Moulden RN

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Excellent article.Please keep me updated with related material.New medications,uses and their side effects.Thank you

Cheryl

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I have been given this for hot flashes, 0.1mg at bedtime..i have no problem with my blood pressure..should i or should i not take this? Thank You

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they just prescribed this for my son who is 4 yrs old. The doctor did not mention anything what the pharmacist told my husband. I was looking for something to help him. Im scared this will do more harm then good.

THERESA

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I have a 4 year old son who just started taking this medication for the first time. For ADHD and other reasons. However it kicked in right away and he was sitting very still and quite plus he fell asleep very quickly. Is that normal? What side affects does this medicine have on children? Does it effect the brain? Will it hurt my child? Will it do more harm then good? Will he be drowsy the next day from this medicine?

Michael Ciocco

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I am currently on Percocet&Fentanyl patches. Should I take clonidine with this? I was given this for withdrawal, which no longer pertains to me. Thank You.

lisa

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I have a 14 year old daughter who hs been pescribed clonidine for tourettes syndrome and adhd! she has been taking it for about 6 weeks now and hardly ticks!!, and her adhd has been a bit better as well, although she also takes dex-amphetimine also!!. only side effect has been light headed when suddenly standing up and much sleepier than usual, but any body who has a child with adhd will agree that that is not such a bad thing lol x

Christina

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My 8 yr old is currently taking .15mg of clonidine split into three daily doeses for ADHD, Tourettes and ODD. He was taking stimulants prior to clonidine and was very thin, but after he began taking this medication, it's been about a month, he has gain about 10 lbs. Has anyone else experienced a rapid weight gain like this? He is very active, and although he is eating better now it still seems like an awful lot of weight for and 8 year old to gain is such a short amount of time.

Debbie

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My son is 16 and was diagnosed with a Mood Disorder, OCD, ADD, & ODD since he was 6, he is also developmentally delayed & now has Anxiety. He has tried so many meds and is very sensitive to the side effects. He was just put on Clonadine and he says that he feels that this helps him, however it does make him very tired and he looks "drugged" up basically. I know that it takes time for the body to get used to the dosage, however, I will continue to monitor him carefully. But I wanted to tell the parents of children with ADHD, ADD & ODD that have been diagnosed at a very young ages, please also look at their diets, & what's going on at home. I say this because until an Master Level Therapist came in the home, I could not see how I contributed to my son's behavior. It was over time that I was shown how our behaviors (mine & his dad's) would affect my son and then result in his negative behavior or to display typical ADD & ODD behaviors. I also learned how certain foods are "triggers" and can intensify symptoms. Also unknown allergies cause behavioral symptoms. I am not a doctor, I am only speaking from personal experience and trial & error. Good luck to you all, our journey is a long and trying one.

Tom

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After 2 back surgeries that were 9 months apart, I became addicted to prescription pain killers. Oxycodone, oxycodine, OxyContin, hydrocodone...you name it. Not only did it relieve the pain, but the euphoria inexperienced was a wonderful side effect. Quitting their usage was difficult because my body could not produce dopamine (a pleasure chemical in the brain) on its own since it was artificially stimulated by the drugs. Most everything that I formerly enjoyed no longer gave me pleasure such as fishing, hunting, playing music, and other hobbies because I didn't receive the dopamine that should have been naturally produced. I no longer cared to do any of those activities, became sedintary, and quite frankly didn't give a sh-t about anything. I tried anti-depressants with no luck. My doctor then prescribed clonidine and within a few week I began to feel better. A month later my doctor doubled my dosage to 0.4 mg. A month later I started to enjoy golfing, I picked up my guitar again, and started taking better care of myself, my business, and my home. I now feel the best I've felt in over a year and life is good. We are now about to ween my off the Lamictal that wasn't working anyway. This is just my personal experience and not a recommendation for anyone. I hope this gives some insight to those that are experiencing similar disappointments and frustrations.

ticha

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My 2yr old grandaughter was just prescribed this mediccation clonidine 0.1mg for insomia and other issues, she has autism I hesitate so much in giving her this pills im scared that something would happen to her or get to dependant on this meds, either way she was whinning an very fussy for most of the night she didint look like she was filling well, so basically what she slept was mostly 5hrs or less its 5am and shes been awake since 4 is it safe to give this medication to her she is a very small child my son that has adhd use to take this medicine but until he was 9yr old an things didint got to nice after that.

marie burton

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My 3 yo son was just diagnosed with autism. The therapists recommended this medication for him, but I'm not so sure about it. I dont want him to get any clumsier, be drowsy, walk around like a zombie, or become dependent on anything that could cause withdrawel symptoms. I would much rather deal with a few tantrums and some hyperactivity.

sbk

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My 4 1/2 year old daughter was diagnosed at 2 1/2 years old with autism and diagnosed a month ago with ADHD. She has had substantial sleep issues starting at 3 years old, and we have successfully been using clonidine for almost a year now. She weighs 38 lbs now, and we are giving her 0.1 mg in the evening. Her sleep is improved, but not perfect. Clonidine seems to have a "knockout" effect 40 min after taking it, but she is well rested in the morning. We tried a dosage of 0.15 and 0.2mg per night, but those were too much and left her groggy in the morning. Our physician has described this as a very safe drug, and we have been happy with it. We also suspect that there has been some carryover effect into the daytime with improved focus (drug mostly worn off by the morning, but not completely), which makes some sense since this is also prescribed as an ADHD medication.

Tanya

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My has been diagnosed with ADHD at the age of 5. He is now 6 1/2 yrs. I believe he is really ADD. He is not really a hyper type of kid but rather a pleasure to his teachers with behavior not being a problem but has a hard time focusing especially when it comes to learning. And it is rather hard at times to get him to buckle down and grasp what we are trying to teach him. He takes 15mg of Focalin for his ADHD to help him focus especially in school I was afraid go higher in dosage. As of the last 4 to 5 months he has been prescribed 0.1 mg of clonidine to help him sleep at night. After so long of resisting this drug I gave in because he really needed it. He would stay up all hours of night which is not good for a child getting up early to go to school and needing to focus. He would find every excuse to stay awake, have tantrums, cry etc. Since clonidine he goes to sleep within the hour he is given it. It was a God send. But I truly do not want him to be dependant on this drug. How addictive can this be? Can he ever go to sleep without it? One Friday I tried not to give it to him and he stayed up untill 2 or 3 am. I call it his night time vitamin. What scared me is the last two nights he is asking for it. "Mommy can I have my night time vitamin now". I also have made it a habit to give him his regular multi vitamin(gummy) right after the dose of clonidine So I don't know what he is really looking forward to. Is he becoming additive to clonidine or what? I look forward to your answers in e-mail thank you.

Mumzy living w/ autistic 12 yr old son

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For those of you looking for help getting kids to sleep without 'drugs': Don't wait another day/night --> Try MELATONIN about 15-20 minutes before bedtime. It is natural and very effective at low dose. It is not habit forming. If your child can't/won't swallow pills - you can crush it (into a fine powder) and mix into a spoon of peanut butter (or whatever creamy treat they like) and it disappears. We called it his 'midnight snack'. When my son caught me putting it into the peanut butter...I said it is called "Magic Sleep Dust", because to me that is exactly what it was. For the first seven years of his life, it was like he only needed from 30 minutes to (if I was lucky) 2 hours of sleep a 'night', then he would be "good to go" for another 24 hours! I was living a nightmare and then one day I finally found a natural remedy: MELATONIN. Look into it and help your child (and yourself!) to some much needed rest. :) Best wishes to all, ~Mumzy

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Has anyone experienced extreme skin irritation where this patch is placed (to be clear, not the outer covering patch, the actual clonidine patch)? My son has a red raised welt from it and the doctor said to keep using it with hydrocortisone cream. I am not happy with this answer... We are not using this med for sleep (he's a great sleeper) but to help our ADHD/learning-challenged son to be less aggressive and out of control when the Vyvanse (which works great but only for about 6-7 hours) has worn off.

ben robinson

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I have Tourette's syndrome it started at age 6 I was put on clonidine .1 milligrams 2 times a day in elementary school and I had to sleep during gym because my first dose was in the morning and the second one was after school hated it as a person who took it before clonidine I used to go skating on the weekends and when I was put on clonidine all that stuff stops I was tired all the time I really had no life in school and at the age of 13 I would act like I was taking it and I would throw it away and for taking it for so long it Made me have high blood pressure. it really ruined my childhood.so before you put your child on this medication please ask a lot of questions please. I'm 33 year old now and I still have Tourette syndrome butt it is very mild to where I don't have to take medication for it.so parents please think twice before you put your child on this medication.especially if your child has a mild case just think twice

Vanessa Bianchi

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My son is 7 years old and has just started taking this medication for his autism and anxiety. He's using the patch. The problem is that the patch keeps falling after a few days of use, when is supposed to last 7 days. Is that okay tho put another one to substitute the fallen patch?