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clonidine

Pronunciation

Generic Name: clonidine (oral) (KLOE ni deen)
Brand Name: Catapres, Kapvay, Kapvay Dose Pack

What is clonidine?

Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily.

Clonidine is used to treat hypertension (high blood pressure). The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD).

Clonidine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about clonidine?

Before you take clonidine, tell your doctor if you have heart disease or severe coronary artery disease, a heart rhythm disorder, slow heartbeats, low blood pressure, a history of heart attack or stroke, kidney disease, or if you have ever had an allergic reaction to a clonidine transdermal skin patch (Catapres TTS).

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Do not take two forms of clonidine at the same time.

If you need surgery, tell the surgeon ahead of time that you are using clonidine. You may need to stop using the medicine for a short time.

Do not stop using clonidine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using clonidine.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Clonidine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

What should I discuss with my healthcare provider before taking clonidine?

You should not take this medication if you are allergic to clonidine.

To make sure clonidine is safe for you, tell your doctor if you have:

  • heart disease or severe coronary artery disease;

  • heart rhythm disorder, slow heartbeats;

  • low blood pressure;

  • a history of heart attack or stroke;

  • pheochromocytoma (tumor of the adrenal gland);

  • kidney disease; or

  • if you have ever had an allergic reaction to a clonidine transdermal skin patch (Catapres TTS).

FDA pregnancy category C. It is not known whether clonidine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Clonidine can pass into breast milk and may harm a nursing baby. Do not take this medication without telling your doctor if you are breast-feeding a baby.

Do not give Kapvay to a child younger than 6 years old.

How should I take clonidine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Do not take two forms of clonidine at the same time.

Clonidine may be taken with or without food.

Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

If you need surgery, tell the surgeon ahead of time that you are using clonidine. You may need to stop using the medicine for a short time.

Do not stop using clonidine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using clonidine.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath) followed by low blood pressure (feeling light-headed, fainting), cold feeling, shallow breathing, weakness, fainting, or pinpoint pupils.

What should I avoid while taking clonidine?

Avoid becoming overheated or dehydrated during exercise and in hot weather.

Drinking alcohol can increase certain side effects of clonidine.

Clonidine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Clonidine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • fast or pounding heartbeats, tremors;

  • a very slow heart rate (fewer than 60 beats per minute);

  • feeling short of breath, even with mild exertion;

  • swelling, rapid weight gain;

  • confusion, hallucinations;

  • flu symptoms;

  • urination problems; or

  • feeling like you might pass out.

Other common side effects may include:

  • drowsiness, dizziness;

  • feeling tired or irritable;

  • cold symptoms such as runny or stuffy nose, sneezing, cough, sore throat;

  • mood changes;

  • sleep problems (insomnia), nightmares;

  • headache, ear pain;

  • mild fever;

  • feeling hot;

  • constipation, diarrhea, pain in your upper stomach;

  • dry mouth, increased thirst; or

  • loss of interest in sex, impotence, difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Clonidine dosing information

Usual Adult Dose for Hypertension:

Initial dose (PO): 0.1 mg orally twice a day (morning and bedtime).
Maintenance dose: 0.2 to 0.6 mg/day given in divided doses.

Initial dose (patches):Clonidine TTS-1 (0.1 mg/24 hr) applied once a week.
Maintenance dose: If after 1 to 2 weeks the desired reduction in blood pressure is not achieved, increase the dosage by adding another TTS-1 film or changing to a larger system.
An increase in dosage above 2 clonidine TTS-3 films is usually not associated with additional efficacy.

Extended-release tablets:
Initial dose: 0.17 mg orally once daily at bedtime. Further increments of 0.09 mg orally once daily may be made at weekly intervals if necessary until the desired response is achieved.
Maintenance dose: 0.17 mg to 0.52 mg orally once daily at bedtime

Extended-release oral suspension:
Initial dose: 0.17 mg (2 mL) orally once daily at bedtime. Further increments of 0.09 mg (1 mL) orally once daily may be made at weekly intervals if necessary until the desired response is achieved.
Maintenance dose: 0.17 mg to 0.52 mg orally once daily at bedtime

Usual Adult Dose for Pain:

Continuous Epidural Infusion:
Initial dose: 30 mcg/hr.
May be titrated up or down depending on pain relief and occurrence of adverse events.
Maximum dose 40 mcg/hr.

Usual Adult Dose for Pheochromocytoma Diagnosis:

0.3 mg orally once. Clonidine is only recommended after baseline determination of plasma catecholamines. Two baseline samples can be obtained five minutes apart from an existing IV line after the patient has remained supine for 90 minutes (a new needle stick could increase catecholamine concentrations and foul the test).

After the initial dose of clonidine, three additional hourly blood samples may be obtained for plasma catecholamine concentration measurements.

Generally, patients with hypertension and pheochromocytoma do NOT show a decrease in plasma catecholamine levels after this "suppression test", whereas hypertensive patients without pheochromocytoma do. False negative tests have been reported.

Usual Adult Dose for Hypertensive Emergency:

0.2 mg orally once. Additional doses of 0.1 mg may be given as needed and tolerated every hour to control this patient's blood pressure. Be cognizant of the risk of stroke or heart attack or other problem associated with aggressive blood pressure reduction, especially in older persons. The maximum recommended total daily dose in any case of emergent hypertension is 0.8 mg.

Some clinicians report a poor antihypertensive effect of clonidine in patients with spinal injuries since this drug acts on the central nervous system to inhibit peripheral sympathetic tone, and the central and peripheral nervous systems are disrupted in these patients.

Usual Adult Dose for Alcohol Withdrawal:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Anxiety:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Benzodiazepine Withdrawal:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Migraine Prophylaxis:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Perimenopausal Symptoms:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Smoking Cessation:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Bipolar Disorder:

0.1 mg orally twice a day or TTS-1 (0.1 mg) transdermal patch once a week.

Usual Adult Dose for Opiate Withdrawal:

0.2 mg orally twice a day or TTS-2 (0.2 mg) transdermal patch once a week.

Usual Pediatric Dose for Attention Deficit Disorder:

May be used alone or as an adjunct to stimulants.

Immediate release (unlabeled indication):
Children less than or equal to 45 kg:
Initial dose: 0.05 mg orally at bedtime. Increase sequentially every 3 to 7 days by 0.05 mg increments as 2 times daily, then 3 times daily, then 4 times daily.
Maximum dose: 0.2 mg/day orally for patients weighing 27 to 40.5 kg; 0.3 mg/day for patients weighing 40.5 to 45 kg.
When discontinuing therapy, taper gradually over 1 to 2 weeks.

Children greater than 45 kg:
Initial dose: 0.1 mg orally at bedtime. Increase sequentially every 3 to 7 days by 0.1 mg increments as 2 times daily, then 3 times daily, then 4 times daily
Maximum dose: 0.4 mg/day
When discontinuing therapy, taper gradually over 1 to 2 weeks.

Extended release (Kapva {R}):
Children greater than or equal to 6 years:
Initial dose: 0.1 mg orally at bedtime. Increase in 0.1 mg/day increments every 7 days until desired response. Doses should be administered twice daily (either split equally or with the higher split dosage given at bedtime).
Maximum dose: 0.4 mg/day orally
Note: Maintenance treatment for greater than 5 weeks has not been evaluated.
When discontinuing therapy, taper daily dose by less than or equal to 0.1 mg every 3 to 7 days.
Transdermal: Children may be switched to the transdermal delivery system after oral therapy is titrated to an optimal and stable dose; a transdermal dose approximately equivalent to the total oral daily dose may be used.

The dose of clonidine extended-release tablets, administered either as monotherapy or as adjunctive therapy to a psychostimulant, should be individualized according to the therapeutic needs and response of the patient. Dosing should be initiated with one 0.1 mg tablet at bedtime, and the daily dosage should be adjusted in increments of 0.1 mg/day at weekly intervals until the desired response is achieved. Doses should be taken twice a day, with either an equal or higher split dosage being given at bedtime.

What other drugs will affect clonidine?

Taking clonidine with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking clonidine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with clonidine, especially:

  • clonidine transdermal skin patches (Catapres TTS);

  • digoxin, digitalis;

  • an antidepressant such as amitriptyline, clomipramine, doxepin, imipramine, nortriptyline, and others;

  • a beta-blocker such as atenolol, carvedilol, labetalol, metoprolol, nadolol, propranolol, sotalol, and others;

  • heart or blood pressure medicine such as amlodipine, diltiazem, nifedipine, verapamil, and others;

  • medicines to treat psychiatric disorders, such as chlorpromazine, clozapine, fluphenazine, haloperidol, olanzapine, perphenazine, prochlorperazine, risperidone, thiothixene, trifluoperazine, and others; or

  • any other drugs to treat high blood pressure or heart problems.

This list is not complete. Other drugs may interact with clonidine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about clonidine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.02. Revision Date: 2013-01-05, 4:42:56 PM.

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