<12 years old
<18 years old
0.1-0.2 mg PO; may follow with additional doses of 0.1 mg qhr PRN to maximum 0.6 mg total dose
0.3-0.6 mg PO q6hr
<6 years old: Not established
≥6 years old (extended-release tablets, Kapvay): 0.1 mg PO qHS initially; may adjust dose by increments of 0.1 mg/day at weekly intervals until desired response; not to exceed 0.4 mg/day
When discontinuing, taper gradually by decrements not to exceed 0.1 mg q3-7Days
PO administration: 0.1 mg qDay; increase by 0.1 mg/day to 0.15-0.75 mg/day if required
TD administration: 100-200 mcg/day patch q7Days
100-300 mcg PO 2 hours befor bedtime, up to 900 mcg/day
0.0025-0.015 mg/kg/day PO for 6 weeks to 3 months
100-200 mcg/day transdermal patch; change q7Days
Apply 100 mcg/day patch; change q7Days, OR
50 mcg PO q12hr initially; may increase up to 400 mcg q12hr
PO administration: 0.025 mg q12hr for 2 weeks prior to menstruation
PO administration: 0.1-0.3 mg q4-6hr; increase by 0.1 mg/day to 0.15-0.75 mg/day if required; do not exceed 2.4 mg/day
TD administration: 100-200 mcg/day patch q7Days; initiate 0.1-0.3 mg PO q4-6hr for first 2 days to allow for adequate drug levels
PO administration: 0.1 mg q12hr
PO administration: 0.4-1.4 mg/day in divided doses
Clonidine suppression testing: 0.3 mg PO for 60-80 kg patient; obtain blood sample 3 hours after administration to supine patient
Extended-release is not to be used interchangeably with immediate-release tablets
Conversion from oral to transdermal
|•||Stimulates alpha-adrenergic receptors in the CNS; which results in decreased sympathetic outflow inhibiting cardioacceleration and vasoconstriction centers.|
|•||Prevents pain signal transmission to the CNS by stimulating alpha-adrenergic receptors in the spinal cord.|
|•||Decreased blood pressure.|
Hypersensitivity to clonidine or any component of adhesive layer of the transdermal system.
|Epidural — injection site infection, anticoagulant therapy, or bleeding problems.|
Use Cautiously in:
|•||Serious cardiac or cerebrovascular disease .|
|•||Geri: Appear on Beers list due to increased risk of orthostatic hypotension and adverse CNS effects in geriatric patients ( dose recommended).|
|•||Pregnancy or lactation (safety not established).|
CV: Bradycardia (4%); heart rate increased (3%); CHF, ECG abnormalities (eg, arrhythmias, AV block, functional bradycardia, sinus node arrest), hypotension (epidural only), orthostatic symptoms, palpitations, Raynaud phenomenon, sinus bradycardia, tachycardia.
CNS: Somnolence (38%); drowsiness (33%); headache (29%); fatigue (27%); dizziness (20%); insomnia (13%); sedation (10%); irritability, nightmare (9%); emotional disorder (5%); abnormal sleep-related event, aggression, sleep terror, tremor (3%); agitation, anxiety, behavioral changes, confusion (epidural only), delirium, delusional perception, depression, malaise, nervousness, nightmares, paresthesia, restlessness, sleep disorder, syncope, visual and auditory hallucinations.
DERM: Alopecia, angioneurotic edema, erythema (transdermal only), hives, pruritus, rash, transient localized skin reactions, urticaria.
EENT: Throat pain (8%); ear pain, nasal congestion (5%); acute otitis media, epistaxis, nasopharyngitis, tearfulness (3%); accommodation disorder, blurred vision, burning or dry eyes, decreased lacrimation, dryness of the nasal mucosa.
GI: Dry mouth (53%); upper abdominal pain (20%); constipation (10%); anorexia, nausea (8%); GI viral (7%); diarrhea (4%); thirst (3%); abdominal pain, hepatitis, mild transient abnormalities in LFTs, parotitis, pseudo-obstruction (including colonic pseudo-obstruction), salivary gland pain, vomiting.
GU: Enuresis (4%); pollakiuria (3%); decreased sexual activity, difficulty in micturition, erectile dysfunction, loss of libido, nocturia, urinary retention.
METAB: Gynecomastia, transient elevations in blood glucose or serum CPK, weight gain.
RESP: Upper respiratory tract infection (11%); asthma, lower respiratory tract infection (3%).
OTHER: Increased body temperature (5%); influenza-like illness (3%); fever, increased sensitivity to alcohol, leg cramps, muscle or joint pain, pallor, thrombocytopenia, weakly positive Coombs test, weakness, withdrawal syndrome.
|•||Additive sedation with CNS depressants, including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.|
|•||Additive hypotension with other antihypertensives and nitrates.|
|•||Additive bradycardia with myocardial depressants, including beta blockers.|
|•||MAO inhibitors, amphetamines, beta blockers, prazosin, or tricyclic antidepressants may decrease antihypertensive effect.|
|•||Withdrawal phenomenon may be increased by discontinuation of beta blockers.|
|•||Epidural clonidine prolongs the effects of epidurally administered local anesthetics.|
|•||May decrease effectiveness of levodopa.|
|•||Increased risk of adverse cardiovascular reactions with verapamil.|
Therapeutic Classification: antihypertensives
Pharmacologic Classification: adrenergics (centrally acting)
Absorption: Well absorbed from the GI tract and skin. Enters systemic circulation following epidural use. Some absorption follows sublingual administration.
Distribution: Vd is approximately 2.1 L/kg. Clonidine is 20% to 40% protein bound.
IV: Distribution half-life is approximately 11 min.
Metabolism: Approximately 50% is metabolized in the liver. The major metabolite is p-hydroxyclonidine.
Epidural: The half-life is approximately 22 h. Cl is approximately 190 min.
|ORAL||30-60 MINUTE||2-4 HOUR||8-12 HOUR|
|TRANSDERMAL||2-3 DAYS||UNKNOWN||7 DAYS|