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Clonidine is an alpha-2 agonist used in pediatrics for hypertension, ADHD adjunct, sleep dysregulation, and withdrawal management.
Baseline and follow-up blood pressure/heart rate monitoring are essential; titrate no more frequently than every 5–7 days to avoid bradycardia or hypotension.
Sedation, dizziness, and dry mouth are common; schedule the largest dose at bedtime and counsel families about school performance monitoring.
Abrupt discontinuation may trigger rebound hypertension or agitation; taper over 3–7 days when stopping or switching formulations.
Transdermal patches deliver steady plasma levels but can cause contact dermatitis; rotate sites weekly and secure edges to prevent detachment in young children.
Use caution with other CNS depressants (benzodiazepines, opioids) and QT-prolonging agents; review medication lists for additive hypotension.
In opioid withdrawal protocols, pair clonidine with scheduled assessments (e.g., WAT-1) and monitor for hypotension before each dose.
Clonidine provides alpha-2 agonist support across neurologic and cardiovascular indications.
Common pediatric uses include ADHD adjunct, hypertension, sleep regulation, and withdrawal support.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Adjunctive therapy for attention-deficit/hyperactivity disorder | Children and adolescents | Yes | Extended-release clonidine (Kapvay) is FDA-approved as monotherapy or adjunct to stimulants for ADHD symptom control. |
| Hypertension requiring additional sympatholytic control | Children and adolescents | No | Consider when first-line agents (ACE inhibitors, ARBs, calcium channel blockers, thiazides) are insufficient or contraindicated. |
| Sleep-onset difficulty associated with neurodevelopmental disorders | Children and adolescents | No | Use off-label after behavioral strategies when insomnia is linked to ADHD, autism spectrum disorder, or anxiety and daytime sedation can be monitored. |
| Autonomic symptoms during opioid withdrawal | Children and adolescents | Yes | Employed in monitored settings to reduce sympathetic surges in withdrawal protocols. |
FDA-approved primary uses with Level A evidence
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Clonidine is associated with sedation, hypotension, and dry mouth.
Abrupt withdrawal can cause rebound hypertension; taper carefully.
Sedation/drowsiness
Common • mild
Hypotension
Common • moderate
Rebound hypertension
Uncommon • serious
Dry mouth
Common • mild
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Administration guidance for clonidine.
Administer at the same times each day. For tablets, give with or without food consistently. Extended-release tablets must not be crushed. Transdermal patches should be applied to hairless skin and rotated weekly.
Taper gradually to avoid rebound hypertension. For sleep support, give the evening dose 1-2 hours before bedtime.
Emergency contact: Seek urgent care for fainting, very slow heart rate, severe drowsiness, or signs of overdose (pinpoint pupils, respiratory depression).
Do not suddenly stop clonidine without medical guidance. Monitor blood pressure at home if recommended.
Different formulations and concentrations
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It decreases sympathetic tone by inhibiting presynaptic norepinephrine release in the brainstem, producing antihypertensive and sedative effects.
Clonidine reduces norepinephrine release via alpha-2 autoreceptor activation.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Clonidine pearls for pediatric practices.
Focus on tapering, vital monitoring, and sedation counseling.
Decrease dose gradually over at least one week to avoid rebound hypertension.
Encourage home blood pressure logs during titration.
Align dosing with bedtime when sedation is desired and communicate with school about potential drowsiness.
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Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Clonidine and monitor your child's response to treatment.
Sedation is common during the first 1–2 weeks. Give the evening dose earlier, add the morning dose only after bedtime sedation is tolerated, and report excessive daytime sleepiness to the clinician.
No. Cutting the patch alters the delivery system and can release too much medicine. Use the prescribed strength and rotate sites weekly to prevent skin irritation.
Apply a new patch to a different hairless site and note the date. Disposable overlay dressings (e.g., Tegaderm) help patches stay on. Contact your clinician if detachment happens often.
Yes, clonidine is frequently combined with stimulants or atomoxetine. Clinicians monitor blood pressure, heart rate, and sedation when doses change.