Clonidine

CATAPRES

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What it isAlpha-2 and imidazoline agonist that reduces sympathetic outflow; hypertension, ADHD and withdrawal states.

Why this oneIts central sympatholysis makes it unusually useful for ADHD, tics and autonomic withdrawal symptoms as well as hypertension.

What limits itAbrupt withdrawal can cause severe rebound hypertension. Sedation, dry mouth and bradycardia limit use; patches have delayed onset and offset.

FDA-approved for

hypertension (1974)
ADHD (ER) (2010)

Off-label

tics
opioid/nicotine withdrawal
menopausal flushing
anesthetic adjunct

FDA label

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FDA dosing	Population	Start	Target	Max
Hypertension	Adult	0.1 mg BID (AM & QHS)	0.2-0.6 mg/day divided	2.4 mg/day

Titration Increase by 0.1 mg/day at weekly intervals

Renal Lower initial dose and monitor closely; no supplemental dose needed after hemodialysis (minimal removal)

Hepatic Undefined

Instructions

Take the larger portion of the daily dose at bedtime to minimize dry mouth and drowsiness
Elderly or renally impaired patients: use a lower initial dose

Cautions

Withdrawal/rebound hypertension if discontinued abruptly
Bradycardia and AV block (with and without concomitant digitalis)
Sedation and drowsiness
Orthostatic symptoms
Increased sensitivity to alcohol

Adverse reactions

Dry mouth (~40%)
Drowsiness (~33%)
Dizziness (~16%)
Constipation (~10%)
Sedation (~10%)
Fatigue/weakness

Pregnancy Pregnancy Category C; crosses the placental barrier; use only if clearly needed

Lactation Undefined

NO BOXED WARNINGS

Principal riskRebound hypertension on abrupt withdrawal

Cost, est. cash$10–$400/month

Generic entry2009

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.