Clonidine: Difference between revisions

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{{MedTemplate

| generic = Clonidine

| brand = Kapvay

| brand = Kapvay (ER, ADHD), Catapres (IR, antihypertensive), Catapres-TTS (transdermal patch), Duraclon (epidural injection)

| classes = Alpha-2 agonist, ADHD medicine

| structure =

| mechanism = ~~Alpha~~-2 adrenergic receptor agonist

| classes = [[:Category:Alpha-2 adrenergic agonists|Alpha-2 adrenergic agonist]], [[:Category:ADHD medicines|ADHD medicine]], [[:Category:Antihypertensives|Antihypertensive]], [[:Category:Opioid withdrawal medicines|Opioid withdrawal medicine]]

| uses = <vote slug="adhd-clonidine-use">Attention-deficit/hyperactivity disorder (Kapvay ER, monotherapy or adjunct to psychostimulants)</vote>, <vote slug="hypertension-use">Hypertension (historical indication, less common in current practice)</vote>, <vote slug="opioid-withdrawal-management-use">Opioid withdrawal symptom management (autonomic hyperactivity)</vote>, <vote slug="tic-disorders-use">Tic disorders / Tourette syndrome (off-label)</vote>, <vote slug="menopausal-hot-flashes-use">Menopausal hot flashes (off-label)</vote>, <vote slug="severe-cancer-pain-epidural-use">Severe cancer pain (epidural, Duraclon)</vote>, <vote slug="procedural-sedation-premed-use">Procedural sedation premedication (off-label)</vote>

| starting_dose = ADHD (Kapvay ER): 0.1 mg PO at bedtime, titrate weekly to 0.4 mg/day divided BID. HTN (IR): 0.1 mg PO BID, titrate by 0.1 mg increments

| preparations = IR tablets 0.1, 0.2, 0.3 mg; ER tablets 0.1, 0.2 mg (Kapvay); transdermal patches 0.1, 0.2, 0.3 mg/24h (TTS-1/2/3, weekly); epidural injection (Duraclon)

| fda_max = 2.4 mg/day (HTN, IR); 0.4 mg/day (ADHD, Kapvay)

| pill_id =

| routes = Oral, transdermal, epidural injection

| onset = 30-60 min (IR oral); 2-3 days to steady state (transdermal patch)

| duration = 8-12 hours (IR); ~7 days (transdermal patch)

| halflife = 12-16 hours<ref name="kapvay-label">FDA Prescribing Information, Kapvay (clonidine hydrochloride extended-release), Concordia/Bausch, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022331s000lbl.pdf</ref>

| bioavailability = ~75-85% (oral); ~60% (transdermal at steady state)<ref name="kapvay-label" />

| pregnancy = Older agent with substantial use experience but limited controlled data; case reports of neonatal sedation and transient hypertension with maternal use near term.{{citation needed}}

| legal = [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, like guanfacine and unlike the psychostimulant alternatives for ADHD<ref name="kapvay-label" />

| mechanism = <vote slug="clonidine-mech-claim">Centrally-acting α2-adrenergic receptor agonist. Less subtype-selective than guanfacine, so engages α2A, α2B, and α2C with associated greater sedation and more peripheral sympatholytic effect. In ADHD the proposed mechanism parallels guanfacine (prefrontal α2A strengthening of working-memory and attention circuits); in opioid withdrawal, central sympatholytic action blunts the autonomic hyperactivity (sweating, tachycardia, hypertension, anxiety, lacrimation) that drives early withdrawal distress; in hypertension, brainstem α2 activation reduces sympathetic outflow.</vote> Sedation and orthostatic hypotension are the dose-limiting effects, and abrupt discontinuation can precipitate '''rebound hypertension''' that is more severe than with guanfacine, particularly at higher chronic doses. Gradual taper is essential<ref name="kapvay-label" />.

}}

~~[[Category:Psychostimulants]]~~

== References ==

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