Clonidine: More Than Just a Blood Pressure Medication
- Kevin Keane
- Oct 1, 2024
- 2 min read
Introduction to Clonidine
Initially approved as an antihypertensive in 1966, Clonidine received approval for treating
ADHD much later, in 2010. This centrally acting alpha 2A agonist is a nonstimulant medication used to manage ADHD symptoms, but it also has numerous other psychiatric applications.
Psychiatric Uses of Clonidine
Beyond ADHD, clonidine is effective in addressing various psychiatric symptoms, including:
Insomnia
Anger and explosive behavior
Anxiety
Affective instability and self-harm in Borderline Personality Disorder
Nightmares, particularly those related to PTSD/trauma
Tics
Impulsivity
Outbursts
Social skills
Excessive sweating
Symptoms of bipolar mania, though not as a primary mood stabilizer
Assisting in the prevention of relapse in opiate addiction and alleviating opiate
withdrawal symptoms
Some evidence to aid in psychotic disorders, like Schizophrenia
Mechanism of Action in ADHD
Clonidine helps reduce impulsive and hyperactive behaviors by impacting the prefrontal cortex, which plays a crucial role in regulating behavior, thoughts, and emotions by processing recent and past memories. This area is vital for decision-making and appropriate behavioral responses.
ADHD Approval and Usage
Clonidine is approved for ADHD treatment in its extended-release form, known as Kapvay.
Side Effects to Monitor
Given its use in treating high blood pressure, clonidine can cause hypotension and sedation. Therefore, it is typically initiated at a very low dose. Its sedative properties also make it a suitable option for aiding sleep.
Comparison to Stimulants
While effective, clonidine has a much smaller effect size for ADHD compared to stimulant medications such as methylphenidate and amphetamines. Clonidine’s effect size is right in line with guanfacine and atomoxetine (Strattera), and therefore not used first line for ADHD.
Dosage Guidelines
Dosage varies based on patient age and the condition being treated:
For daytime ADHD management: Up to 0.1 mg three times daily
For sleep: 0.1 to 0.4 mg taken 30 minutes before bedtime
For anxiety as needed: Typically 0.1 mg, sometimes starting with half a pill
For children under 16: Always start with half a pill for daytime uses
The extended-release form, Kapvay, taken at night, lasts 24 hours and is FDA-approved for ADHD
Common Side Effects
Watch for symptoms like:
Dizziness, particularly upon standing
Dry mouth
Constipation
Sedation or lethargy
Written by:
Joseph Gagnon Jr.