Clonidine Hydrochloride(kloe’ ni deen)
Oral: Apo-Clonidine (CAN), Catapres, KapvayDNC
Transdermal preparations: Catapres-TTS-1, Catapres-TTS-2, Catapres-TTS-3, Dixarit (CAN), Duraclon
Analgesic: Duraclon
PREGNANCY CATEGORY C
Drug Classes
Antihypertensive
Central analgesic
Sympatholytic (centrally acting)
Therapeutic Actions
Stimulates CNS alpha2-adrenergic receptors, inhibits sympathetic cardioaccelerator and vasoconstrictor centers, and decreases sympathetic outflow from the CNS.
Indications
Hypertension, used alone or as part of combination therapy
Treatment of severe pain in cancer patients in combination with opiates; epidural more effective with neuropathic pain (Duraclon)
Treatment of ADHD in children 6–17 yr, as monotherapy or in combination with stimulants (Kapvay)
Unlabeled uses: Tourette syndrome; migraine, decreases severity and frequency; menopausal flushing, decreases severity and frequency of episodes; chronic methadone detoxification; rapid opiate detoxification (in doses up to 17 mcg/kg/day); alcohol and benzodiazepine withdrawal treatment; management of hypertensive “urgencies” (oral clonidine “loading” is used; initial dose of 0.2 mg then 0.1 mg every hour until a dose of 0.7 mg is reached or until BP is controlled); atrial fibrillation; post-herpetic neuralgia, smoking cessation (transdermal), hot flashes, hyperhidrosis, ulcerative colitis, diabetic diarrhea
Contraindications and Cautions
Contraindicated with hypersensitivity to clonidine or any adhesive layer components of the transdermal system.
Use cautiously with severe coronary insufficiency, recent MI, cerebrovascular disease; chronic renal failure; pregnancy, lactation.
Available Forms
Tablets—0.1, 0.2, 0.3 mg; ER tabletsDNC—0.1, 0.2 mg; modified-release tablets—0.1 mg; transdermal—0.1, 0.2, 0.3 mg/24 hr; epidural injection—100 mcg/mL, 500 mcg/mL
Dosages
Adults
Oral therapy
Individualize dosage. Initial dose is 0.1 mg bid; for maintenance dosage, increase in increments of 0.1 or 0.2 mg to reach desired response. Common range is 0.2–0.6 mg/day, in divided doses or once daily if using extended-release form; maximum dose is 2.4 mg/day. Minimize sedation by slowly increasing daily dosage; giving majority of daily dose at bedtime. Modified-release tablets use same dosage, but are not interchangeable with
other forms; dosage adjustment may be needed if switching between forms.
other forms; dosage adjustment may be needed if switching between forms.
Transdermal system
Apply to a hairless area of intact skin of upper arm or torso once every 7 days. Change skin site for each application. If system loosens while wearing, apply adhesive overlay directly over the system to ensure adhesion. Start with the 0.1-mg system (releases 0.1 mg/24 hr); if, after 1–2 wk, desired BP reduction is not achieved, add another 0.1-mg system, or use a larger system. Dosage of more than two 0.3-mg systems does not improve efficacy. Antihypertensive effect may only begin 2–3 days after application; therefore, when substituting transdermal systems, a gradual reduction of prior dosage is advised. Remove old system before applying new one. Previous antihypertensive medication may have to be continued, particularly with severe hypertension.
Epidural
Pain management: 30 mcg/hr by continuous epidural infusion.
Pediatric patients 6–17 yr
ADHD: Initially, 0.1 mg PO at bedtime; titrate at 0.1 mg/wk to a total of 0.2 mg, with 0.1 mg in AM and 0.1 mg in PM, then 0.1 mg in AM and 0.2 mg in PM. Maintenance dose, 0.2 mg in AM and 0.2 mg in PM. If discontinuing, taper in increments of no more than 0.1 mg every 7 day (Kapvay only).
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