Clonidine (Catapres)

Class

Alpha-2 adrenergic agonist

Mechanism

Stimulates central alpha-2 receptors, reducing sympathetic outflow, which lowers blood pressure and modulates noradrenergic activity involved in attention, arousal, and autonomic regulation.

FDA-Approved Use

Hypertension, attention-deficit/hyperactivity disorder (ADHD) in children aged 6 years and older

Off-Label Use

Opioid withdrawal, Tourette syndrome, anxiety disorders, sleep disturbances, post-traumatic stress disorder (PTSD)-related hyperarousal and sleep disturbances, agitation and aggression in neurodevelopmental disabilities (especially with hyperactivity or impulsivity)

Formulation

Oral tablets, transdermal patch

Titration

Start at 0.1 mg p.o. nightly, titrate slowly based on clinical response, typical dose range 0.1–0.3 mg/day

Dose Range

0.1–0.3 mg/day

Kinetics

Half-life approximately 12–16 hours, metabolized hepatically, excreted renally

Common AEs

Drowsiness, dry mouth, constipation, hypotension, fatigue

Serious/Rare AEs

Rebound hypertension with abrupt discontinuation—taper gradually

Monitoring

Monitor blood pressure and heart rate regularly, especially during dose changes or discontinuation

Black Box Warning

None

Considerations

Use caution in elderly patients due to increased risk of hypotension and orthostatic falls. Clonidine may improve impulsivity and irritability in intellectual disabilities and neurodevelopmental disorders. In traumatic brain injury (TBI), it is used off-label for posttraumatic headache prophylaxis and trauma-related nightmares, particularly when comorbid with PTSD.