Clonidine

Clonidine, sold under the brand names Catapres and Kapvay, among others, is an α2-adrenergic receptor agonist, hypotensive, sedative and anxiolytic drug used to treat high blood pressure, attention deficit hyperactivity disorder, perioperative pain, drug withdrawal (e.g., alcohol, opioids, or nicotine), and menopausal flushing. Clonidine is sometimes prescribed off-label for tics. It is used orally (by mouth), by injection, or as a transdermal skin patch.

Common side effects include dry mouth, dizziness, headaches, hypotension, and sleepiness. If rapidly stopped, withdrawal effects may occur, such as a dangerous rise in blood pressure. It is available as a generic medication.

Medical uses

thumb|left|200px|Clonidine tablets and transdermal patch

Clonidine is used to treat high blood pressure, attention deficit hyperactivity disorder (ADHD); drug withdrawal, including from (alcohol, opioids, and/or nicotine); menopausal flushing, diarrhea, and certain pain conditions. Many people with essential hypertension experience increased sympathetic nervous system activity, in addition to renin–angiotensin–aldosterone system activation. A 2024 network meta-analysis of imidazoline receptor agonists (i.e., moxonidine and clonidine) reported that this drug class produced ambulatory blood pressure reductions that were close in magnitude to those of commonly used first-line antihypertensive drug classes, but with higher odds of adverse effects such as dry mouth and sedation, especially with clonidine. A 2025 review of randomized and observational studies on transdermal clonidine reported that once-weekly patch formulations achieve blood pressure reductions similar to beta blockers, calcium channel blockers and diuretics, while reducing the risk of withdrawal-related rebound hypertension compared with oral clonidine.

Clonidine is not considered a first-line treatment for hypertension due to its propensity to cause sedation and xerostomia compared with other antihypertensive medications (e.g., angiotensin-converting enzyme inhibitors). When used for blood pressure control, clonidine is typically reserved for hypertensive emergencies rather than routine management hypertension, but it is considered appropriate for treating resistant hypertension. |name="Psychostimulants"|group="note" Clinical guidelines and comparative-efficacy reviews regard psychostimulant medications (i.e., amphetamine and methylphenidate) as first-line pharmacotherapy for ADHD, while non-stimulant medications such as clonidine are recommended as second-line options because their effect sizes are smaller than those of psychostimulants. Non-stimulant medications, including clonidine, are typically used in individuals who do not respond adequately to psychostimulants, cannot tolerate psychostimulant adverse effects, have contraindications such as a high risk of psychostimulant misuse, or who have a preference for a non-stimulant treatment. Unlike psychostimulants, clonidine is regarded as having no abuse potential due in part to a lack of dopaminergic activity along the mesolimbic pathway.

Clonidine is also used as an add-on to psychostimulant medications in individuals who have a partial response to psychostimulants, cannot tolerate higher psychostimulant doses, or experience notable evening symptoms.

Sleep disturbances are common in individuals with ADHD and may arise both from the disorder itself and as an adverse effect of psychostimulant medications, which can cause delayed sleep onset and insomnia. Whilst clonidine's sedative properties, particularly in its immediate-release formulation, can limit its acceptability as a monotherapy for core ADHD symptoms during the daytime, it has been used as a sleep aid in ADHD individuals who are also treated with psychostimulants and experience insomnia. Whilst clonidine itself has limited clinical utility as a monotherapy for postoperative pain, its combination with opioid medications may allow adequate pain relief to be achieved at lower opioid doses, which may reduce the frequency and severity of opioid-related adverse effects. In one meta-analysis of clonidine RCTs, overall adverse event rates did not differ significantly between clonidine and placebo. It can alleviate opioid withdrawal symptoms by reducing the sympathetic nervous system response such as tachycardia and hypertension, hyperhidrosis (excessive sweating), hot and cold flashes, and akathisia. It may also be helpful in aiding smokers to quit. The sedation effect can also be useful. Clonidine may also reduce severity of neonatal abstinence syndrome in infants born to mothers that are using certain drugs, particularly opioids. In infants with neonatal withdrawal syndrome, clonidine may improve the neonatal intensive care unit Network Neurobehavioral Score.

Clonidine has also been suggested as a treatment for rare instances of dexmedetomidine withdrawal.

Clonidine suppression test

The reduction in circulating norepinephrine by clonidine was used in the past as an investigatory test for phaeochromocytoma, which is a catecholamine-synthesizing tumor, usually found in the adrenal medulla. In a clonidine suppression test, plasma catecholamine levels are measured before and 3 hours after a 0.3 mg oral test dose has been given to the patient. A positive test occurs if there is no decrease in plasma levels. It has also been studied as a way to calm acute manic episodes. Clonidine can be used in restless legs syndrome. It can also be used to treat facial flushing and redness associated with rosacea. It has also been successfully used topically in a clinical trial as a treatment for diabetic neuropathy. Clonidine can also be used for migraine headaches and hot flashes associated with menopause. Clonidine has also been used to treat refractory diarrhea associated with irritable bowel syndrome, fecal incontinence, diabetes, diarrhea associated with opioid withdrawal, intestinal failure, neuroendocrine tumors, and cholera. Clonidine can be used in the treatment of Tourette syndrome (specifically for tics). Clonidine has also had some success in clinical trials for helping to remove or ameliorate the symptoms of hallucinogen persisting perception disorder (HPPD).

Adverse effects

The most common adverse side effects of clonidine are dry mouth and sedation.

Physical

Cardiovascular side effects can include hypotension (including orthostatic hypotension) and bradycardia; atrioventricular block and other bradyarrhythmias have also been reported.

Gastrointestinal side effects can include xerostomia, constipation, nausea, and vomiting. Clonidine appears in high concentration in breast milk; a nursing infant's serum clonidine concentration is approximately 2/3 of the mother's. Caution is warranted in women who are pregnant, planning to become pregnant, or are breastfeeding.

Pharmacology

{| class="wikitable floatright" style="font-size:small;"

|+ Clonidine

! Site !! Ki (nM) !! Species !! Ref

| || >1,000 || Human ||

| 5-HT2A || >10,000 || Human ||

| α1B || 316.23 || Human ||

| α2B ||69.18 – 309.0 || Human ||

| I1 || 31.62|| Bovine ||

|- class="sortbottom"

| colspan="4" style="width: 1px;" | The Ki refers to a drug's affinity for a receptor. The smaller the Ki, the higher the affinity for that receptor. Reported imidazoline-2 binding is measured in the cortex — I2 receptor bindings measured in stomach membranes are much lower.

Pharmacodynamics

Clonidine produces most of its pharmacodynamic effects by acting as a non-selective partial agonist at α2 adrenoceptors (α2A, α2B, and α2C), where it can mimic the actions of endogenous norepinephrine at these receptors in the central nervous system and the sympathetic nervous system. α2 adrenoceptor activation decreases noradrenergic arousal signaling in the ascending reticular activating system, can modify prefrontal cortical network activity relevant to attention, and suppresses nociceptive signaling in the dorsal horn of the spinal cord. This effect has been used as part of a "growth hormone test," which can assist with diagnosing growth hormone deficiency in children.

Pharmacokinetics

After being ingested, clonidine is absorbed into the blood stream rapidly with an overall bioavailability around 70–80%. Peak concentrations in human plasma occur within 60–90 minutes for the "immediate release" (IR) version of the drug, which is shorter than the "extended release" (ER/XR) version. Clonidine is fairly lipid soluble with the logarithm of its partition coefficient (log P) equal to 1.6; Less than half of the absorbed portion of an orally administered dose will be metabolized by the liver into inactive metabolites, with roughly the other half being excreted unchanged by the kidneys.

Measurements of the half-life of clonidine vary widely, between 6 and 23 hours, with the half-life being greatly affected by and prolonged in the setting of poor kidney function. while other work contradicts this. A similar N=5 study by Davies et al. (1977) found a narrower range of half-lives, between 6.7 and 13 hours (mean 8.6),

History

Clonidine was introduced in 1966. It was first used as a hypertension treatment under the trade name of Catapres.

Society and culture

Brand names

As of June 2017, clonidine is marketed under many brand names worldwide: Arkamin, Aruclonin, Atensina, Catapin, Catapres, Catapresan, Catapressan, Chianda, Chlofazoline, Chlophazolin, Clonid-Ophtal, Clonidin, Clonidina, Clonidinã, Clonidine, Clonidine hydrochloride, Clonidinhydrochlorid, Clonidini, Clonidinum, Clonigen, Clonistada, Clonnirit, Clophelinum, Dixarit, Duraclon, Edolglau, Haemiton, Hypodine, Hypolax, Iporel, Isoglaucon, Jenloga, Kapvay, Klofelino, Kochaniin, Lonid, Melzin, Menograine, Normopresan, Paracefan, Pinsanidine, Run Rui, and Winpress. It is marketed as a combination drug with chlortalidone as Arkamin-H, Bemplas, Catapres-DIU, and Clorpres, and in combination with bendroflumethiazide as Pertenso.