Clonidine (Kapvay)
Antihypertensive (norepinephrine receptor agonist at alpha-2)
- ADHD2
- Mania/mixed3
- PTSD3 (nightmares)
- Hypnotic3
- Borderline1 (prn for self harm)
- Opioid2 (for withdrawal and prevention)
- Autism2
- SE-sweating2
- Schizophrenia negative symptoms3
- Nicotine3
- Tics1
- Hot flashes3
- Panic3
- Agitation in dementia (anecdotal benefits, no research)
- Migraine prevention
Features
Dosing
ADHD and most other conditions: ER 0.1-0.4 mg/day (higher dosing for IR/patch, see below), start 0.1 mg and raise every 5-7 days toward 0.2 mg/d then dose based on response.
Self-cutting (0.1-0.2 mg instant-release prn).
Opioid use disorder: Can give 0.1mg prn WD or nightly (besides treating WD, it also prevents opioid use once sober).
Can give all at night. Skin patch (weekly) is better tolerated. Available in forms equivalent to 0.1, 0.2, 0.3 mg/d IR. All forms are generic.
Agitation in dementia: Patch 0.1 mg weekly.
Half life 12hr (IR), 12hr (XR). Peak: 2hr (IR), 6hr (XR).
Management
ER is best studied in ADHD, but weekly patch better tolerated Benefits built up over 2-4 weeks. Can be used with stimulant in ADHD.
TOLERABILITY: Dry mouth, somnolence, dizziness, constipation, fatigue, headache. Guanfacine less sedating.
RISKS: Hypotension, falls.
WITHDRAWAL: Rebound hypertension and anxiety if stop suddenly after long term use. Taper dose in no more than 0.1 mg/day decrements, every 3 to 7 days.
EMR Text
ADHD
Clonidine use based on FDA approval in ADHD.
Clonidine side effects, including hypotension, reviewed with patient.
Bipolar
Clonidine use based on randomized controlled trials in bipolar disorder where it reduced manic symptoms.
Clonidine side effects, including hypotension, reviewed with patient.
Opioid Use Disorder
Clonidine use based on randomized controlled trials in opioid use disorder where it reduced withdrawal symptoms and may prevent relapse into opioid use.
Clonidine side effects, including hypotension, reviewed with patient.
Nicotine Use Disorder
Clonidine use based on small randomized controlled trials in nicotine cessation.
Clonidine side effects, including hypotension, reviewed with patient.
Tics
Clonidine use based on multiple randomized controlled trials where it reduced tics in Tourette syndrome.
Clonidine side effects, including hypotension, reviewed with patient.
Autism
Clonidine use based on randomized controlled trials in autism.
Clonidine side effects, including hypotension, reviewed with patient.
Negative symptoms in schizophrenia
Clonidine use based on small randomized controlled trials where it improved negative symptoms in schizophrenia.
Clonidine side effects, including hypotension, reviewed with patient.
Panic
Clonidine use based on small trials in panic disorder.
Clonidine side effects, including hypotension, reviewed with patient.
PTSD
Clonidine use based on small trials in PTSD and nightmares.
Clonidine side effects, including hypotension, reviewed with patient.
Self harm
Clonidine use based on a randomized controlled trial where it prevented self injury.
Clonidine side effects, including hypotension, reviewed with patient.