Clonidine is a centrally acting alpha-adrenergic agonist hypotensive drug. It is used to treat-

• High blood pressure
• Attention deficit hyperactivity disorder (ADHD)
• Anxiety disorders
• Withdrawal from alcohol and opiod drugs
• Smoking cessation
• Migraine
• Painful menstrual periods
• Hot flushes from menopause
• Diarrhea
• Tourette’s syndrome
• Sleep disorders
• Acute and chronic pains
• Cancer

It is available as an oral tablet, a patch and an oral extended release tablet. The brand name for this is Catapres and Kapvay and generic name is Clonidine Hcl.

Tourette’s syndrome 

It is a nervous system disorder which is characterized by repetitive, involuntary movements and vocalizations called tics. It leads to compulsive actions and other behavioural symptoms. Clonidine can be used to treat this syndrome. It helps to reduce the severity and frequency of tics.

Clonidine is given once a day which can be in the morning or in the evening. The dose may increase by two or three times a day depending on how much is required.

• Two times a day- once in the morning and once in the evening between 10-12 hours apart.
• Three times a day- once in the morning, next in afternoon and last dose at bedtime between 4 hours apart. Small doses should be taken because it is rapidly removed from the body.

Starting dose is low of 0.05 mg/day and slowly increases over several weeks to 0.15-0.30 mg/day. High doses causes hypotension, dizziness and sedation. If it is withdrawn from use on a patient, the dosage should be reduced gradually.

Attention deficit hyperactivity disorder (ADHD)

It is a chronic brain disorder which is characterized by problems paying attention, excessive activity, hyperactivity, impulsiveness and difficulty controlling behaviour clonidine helps to reduce hyperactive symptoms. It helps to balance the activity of certain brain receptors which help to reduce hyperactivity and impulsivity. It is also common in children diagnosed with Tourette’s syndrome. The exact cause for ADHD is not known.

In 2010, clonidine was approved by Food and Drug Administration (FDA) to treat ADHD in children.

It works by increasing attention and decreasing restlessness in children and adults who are overactive, cannot concentrate for very long, or are easily distracted and impulsive. This medicine is used as part of a total treatment program that also includes social, educational, and psychological treatment. They can be used in children 6-18 years of age.

Clonidine is available in brand name called Kapvay which is extended-release tablets to treat ADHD. It is given once a day which can be in the morning or in the evening. The dose may increase by two or three times a day depending on how much is required.

• Two times a day – once in the morning and once in the evening between 10-12 hours apart.
• Three times a day- once in the morning, next in afternoon and last dose at bedtime between 4 hours apart. Small doses should be taken because it is rapidly removed from the body.

Clonidine is not associated with side effects in ADHD but sometimes it leads to-

• Fatigue
• Headache
• Dizziness
• Dry mouth
• Constipation

 It is given in oral extended release tablet in 6 years and older with initial dose 0.1 mg in evening and maximum dose of 0.4 mg/day is divided into 2 doses.

Sleep onset disorders

It is difficulty in getting sleep which includes insomnia, problems falling asleep and staying asleep which affects sleep. Clonidine helps to fall asleep. It is given once a day about an hour before bedtime.

Guide for  Dosage, Benefits and Risks

Dosage

Clonidine is used as a tablet and an extended-release tablet to take by mouth and also as topical patches applied over skin. It starts it work within about 45 minutes of taking it.

• Tablets- taken two times a day at evenly spaced intervals these contain gelatine and lactose
• Extended-release tablet- taken once or twice. It should be swallowed as a whole. Do not split, chew or crush them.

Take the medicine as directed by the doctor. It may start on a low dose and gradually increase, not more than once every week.

Oral adult dose is 0.1, 0.2 and 0.3 mg twice daily, maximum oral dose is 2.4 mg daily

Topical patches 0.1, 0.2 and 0.3 mg delivered over 24 hours and should be applied to an area of hairless skin once every 7 days. When applying a new topical patch, a different area of skin should be used.

Dose in ADHD

Child dose between age 6-17 years is 0.1 mg to be taken at bedtime. Dose may be increased by an additional 0.1 mg per day every week until the symptoms are better. Total daily doses are 0.1-0.4 mg per day. The total dose is divided into 2 doses taken twice per day.

If the dose is missed, skip the missed dose and take the next dose as scheduled. Do not take more than the prescribed total daily amount of clonidine in a 24 hour period.

Benefits

Clonidine is a medication that was originally used to treat high blood pressure by decreasing heart rate and relaxing blood vessels so that blood can flow more easily through the body. This  now has a number of other medical benefits which include-

• Catapres is an immediate-release form of clonidine that is used to treat hypertension
• Kavpay is an extended-release form of clonidine that is used to treat ADHD
• To treat tics which occur in Tourette’s syndrome
• To reduce cramping during the menstrual cycle in women
• To quit smoking
• To treat chronic and acute pain
• Daignose pheochromocytoma which is a tumor that develops on a gland near the kidneys
• Axiety issues
• Addition related withdrawal for alcohol and opiod drugs
• Symptoms of narcotic withdrawal
• Diabetic neuropathy
• To manage severe cancer related pain
• Diabetes-linked diarrhea
• Restless leg syndrome
• Enhances the effect of stimulant medication
• Appetite neutral

Risks

One of the biggest risks involved in stopping clonidine is the tendency for people to experience rapid heartbeats and high blood pressure as symptoms of clonidine withdrawal. Therefore, stopping clonidine on own is not advised. It is not considered to be a major drug of abuse, however it doses have the potential to be abused. With prolonged use of clonidine there appears withdrawal syndrome which consists of psychological symptoms which include-

• Nervousness
• Anxiety
• Difficult in concentrating
• Tremors
• Headache
• Increased heart rate and blood pressure

Another risk is that if it is stopped abruptly this may cause rebound high blood pressure. Instead, the dose should be decreased gradually.

Avoid drinking alcohol. It may increase certain side effects of clonidine.

Along with risk, there are certain side effects also-

• Sedation
• Drowsiness
• Dizziness
• Headache
• Fever
• Fatigue
• Weakness
• Constipation
• Drying of the mouth
• Sleep problmes
• Diarrhea
• Stomach pain

Some less frequent side effects are-

• Heart palpitations
• Congestive heart failure
• Atrioventricular blockage
• Anxiety
• Depression
• Withdrawal symptoms
• Low blood pressure
• Hallucinations
• Insomnia
• Restlessness
• Skin rash
• Decreased sexual ability
• Ejaculatory dysfunction

Contact your doctor if these side effects become serious.

In case of overdose following symtopms are seen-

• Fainting
• Slow heart rate
• Difficulty breathing
• Slurred speech
• Shivering
• Tiredness
• Weakness
• Chills and feeling cold

Conclusion : Clonidine is an oral and topical drug prescribed for the treatment of high blood pressure. It is a long term medication which should be taken as prescribed. If it is stopped suddenly then lead to a withdrawal reaction.    Side effects, warnings, precautions, drug interactions, pregnancyand breastfeeding safety information should be reviewed prior to taking any medication. Ask your doctor how to safely stop using this medicine otherwise will lead to risk factors.