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clonidine
generic
Black Box Warnings .
Appropriate Use
dilute 500 mcg/mL strength product in an appropriate solution prior to use
Obstetrical, Postpartum, or Perioperative Use
weigh risk/benefit; epidural clonidine generally not recommended for obstetrical, postpartum, or perioperative pain management due to risk of hemodynamic instability, esp. hypotension and bradycardia
Adult Dosing .
Dosage forms: TAB: 0.1 mg, 0.2 mg, 0.3 mg; INJ: various
HTN
- [0.1-0.4 mg PO bid]
- Start: 0.1 mg PO bid, may incr. by 0.1 mg/day qwk; Max: 2.4 mg/day; Info: consider lower start dose in elderly pts; taper dose over 2-4 days to D/C
severe cancer pain, adjunct tx
- [individualize dose epidurally]
- Start: 30 mcg/h epidurally; Info: taper dose over 2-4 days to D/C
Tourette syndrome (off-label)
- [0.1-0.3 mg/day PO divided bid-qid]
- Start: 0.025-0.05 mg PO qd, then may titrate slowly; Max: 0.6 mg/day; Info: taper dose over 2-4 days to D/C
renal dosing
- [see below]
- renal impairment: consider decr. usual start dose, titrate slowly
- HD: consider decr. usual start dose, titrate slowly; no supplement after dialysis; PD: consider decr. usual start dose, titrate slowly; no supplement
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 0.1 mg, 0.2 mg, 0.3 mg; ER TAB: 0.1 mg; INJ: various
Special Note
- [formulation clarification]
- Info: clonidine ER products not interchangeable; do not substitute on a mg to mg basis; retitrate if switching between products
severe intractable cancer pain, adjunct tx
- [individualize dose epidurally]
- Start: 0.5 mcg/kg/h epidurally; Info: taper dose over 2-4 days to D/C
ADHD
- [extended-release form, 6-17 yo]
- Dose: 0.1-0.4 mg/day ER PO divided qd-bid; Start: 0.1 mg ER PO qhs, may incr. by 0.1 mg/day qwk; Max: 0.4 mg/day ER; Info: divide dose bid if >0.2 mg/day, and give either equal or higher split dose at bedtime; do not cut/crush/chew ER tab; taper dose by no more than 0.1 mg/day q3-7 days to D/C
- [immediate-release form, 27-40.5 kg (off-label)]
- Dose: 0.003-0.005 mg/kg/day PO divided tid-qid; Start: 0.05 mg PO qhs, then may incr. by 0.05 mg/day q3-7 days; Max: 0.05 mg/dose up to 0.2 mg/day; Info: taper dose over 2-4 days to D/C
- [immediate-release form, 40.5-45 kg (off-label)]
- Dose: 0.003-0.005 mg/kg/day PO divided tid-qid; Start: 0.05 mg PO qhs, then may incr. by 0.05 mg/day q3-7 days; Max: 0.1 mg/dose up to 0.3 mg/day; Info: taper dose over 2-4 days to D/C
- [immediate-release form, >45 kg (off-label)]
- Dose: 0.003-0.005 mg/kg/day PO divided tid-qid; Start: 0.1 mg PO qhs, then may incr. by 0.1 mg/day q3-7 days; Max: 0.1 mg/dose up to 0.4 mg/day; Info: taper dose over 2-4 days to D/C
HTN (off-label)
- [12 yo and older]
- Dose: 0.2-0.8 mg/day PO divided bid; Start: 0.2 mg/day PO divided bid, may incr. by 0.1 mg/day qwk; Max: 2.4 mg/day; Info: taper dose over 2-4 days to D/C
HTN, acute severe (off-label)
- [0.05-0.1 mg PO q1h prn]
- Max: 0.8 mg/total dose; 8h; Info: for pts w/ non-life-threatening sx
Tourette syndrome (off-label)
- [7 yo and older]
- Dose: 0.1-0.3 mg/day PO divided bid-qid; Start: 0.025-0.05 mg PO qd, then may titrate slowly; Max: 0.4 mg/day; Info: taper dose over 2-4 days to D/C
neonatal opioid withdrawal syndrome, adjunct tx (off-label)
- [0.5-1 mcg/kg/dose PO q3-6h]
- Max: 8 mcg/kg/day; Info: refer to institutional protocol
renal dosing
- [see below]
- renal impairment: consider decr. usual start dose, titrate slowly
- HD: consider decr. usual start dose, titrate slowly; no supplement after dialysis; PD: consider decr. usual start dose, titrate slowly; no supplement
hepatic dosing
- [not defined]