clonidine (Rx)

Hypertension

Immediate-release tablets

• 0.1 mg PO q12hr
• Range: 0.1-0.2 mg/day q12hr; not to exceed 2.4 mg/day

Transdermal

• Apply 1 patch q7Days; start with 0.1 mg; increase by 0.1 mg after q1-2Week interval; usual dose range is 0.1-0.3 mg qWeek

Cancer Pain

Epidural infusion

• Severe pain in patients with cancer not adequately relieved by opioid analgesics alone
• Initial: 30 mcg/hr
• Titrate as required for pain relief or presence of side effects
• Limited data on doses exceeding 40 mcg/hr

Acute Hypertension (Off-label)

0.1-0.2 mg PO; may follow with additional doses of 0.1 mg qhr PRN to maximum 0.6 mg total dose

EtOH Withdrawal (Off-label)

0.3-0.6 mg PO q6hr

Smoking Cessation (Off-label)

PO administration: 0.1 mg qDay; increase by 0.1 mg/day to 0.15-0.75 mg/day if required

TD administration: 100-200 mcg/day patch q7Days

Restless Legs Syndrome (Off-label)

100-300 mcg PO 2 hours befor bedtime, up to 900 mcg/day

Tourette's Syndrome (Off-label)

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

Cyclosporine Nephrotoxicity (Off-label)

100-200 mcg/day transdermal patch; change q7Days

Menopausal Flushing (Off-label)

Apply 100 mcg/day patch; change q7Days, OR

50 mcg PO q12hr initially; may increase up to 400 mcg q12hr

Dysmenorrhea (Off-label)

PO administration: 0.025 mg q12hr for 2 weeks prior to menstruation

Opioid Withdrawal (Off-label)

PO administration: 0.1-0.3 mg q4-6hr; increase by 0.1 mg/day to 0.15-0.75 mg/day if required; do not exceed 2.4 mg/day

TD administration: 100-200 mcg/day patch q7Days; initiate 0.1-0.3 mg PO q4-6hr for first 2 days to allow for adequate drug levels

Postherpetic Neuralgia (Off-label)

PO administration: 0.1 mg q12hr

Psychosis (Off-label)

PO administration: 0.4-1.4 mg/day in divided doses

Pheochromocytoma Diagnosis (Off-label)

Clonidine suppression testing: 0.3 mg PO 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

Cancer pain

• Dilute 500 mcg/mL to 100 mcg/mL with 0.9% NaCl before administration
• 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

Dosing Modifications

Renal Impairment

• Impact of renal impairment not assessed
• Initial dose should be based on amount of renal impairment
• Monitor carefully for hypotension and bradycardia
• Removed minimally during hemodialysis; no need to redose following dialysis

Hypertension

>12 years old

• Immediate-release tablets: 0.2 mg/day PO divided q12hr; increase qWeek; maintenance dose range, 0.2-0.6 mg/day q12hr; not to exceed 2.4 mg/day
• Transdermal patch: 0.1 mg patch q7Day 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 (ie, 2 clonidine 0.3 mg patches)

<12 years old

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

<18 years old

• Extended-release tablets (Jenloga, Nexiclon XR): Safety and efficacy not established

ADHD

<6 years old: Not established

≥6 years old (extended-release tablets, Kapvay): 0.1 mg PO qHS 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 q3-7Days

Dosing considerations

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

Cancer Pain

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

Epidural infusion: 0.5 mcg/kg/hr initially; adjust according to clinical response  

Dosing considerations

• 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

Administration

ADHD

• Doses 0.2 mg/day or greater should be divided BID, 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 impairment
• Monitor carefully for hypotension and bradycardia
• Removed minimally during hemodialysis, so no need to redose following dialysis

Hypertension

Immediate-release tablets: 0.1 mg PO qHS

Dosing considerations

Not recommended as routine treatment for hypertension (Beers criteria)

Potential for orthostatic hypotension and adverse CNS effects

May cause bradycardia

Immediate release: Lower initial doses than for nongeriatric adult dosing, as well as gradual adjustments, are recommended

Extended release: May require lower initial dose than for nongeriatric adult dosing