Clonidine for ADHD: How It Works, Side Effects, & Precautions

What Is Clonidine?

Clonidine is FDA-approved for attention-deficit hyperactivity disorder (ADHD) in both adults and children ages 6 and older. Only the extended-release tablet form of Clonidine is approved for ADHD. Clonidine is also available as the brand name medication Kapvay.  It has demonstrated effectiveness in managing the symptoms of ADHD and improving impulse control. Additionally, clonidine has several off-label uses, such as Tourette syndrome, aggression, and sleep disturbances with ADHD.

An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone. While these off-label uses require further research and individualized consideration, they highlight the potential for clonidine to provide benefits beyond its primary use.

It works differently from stimulant medications and offers an alternative for those who may not respond well to or prefer to avoid stimulants. It’s important to consult with your doctor to determine the most appropriate treatment approach for your specific needs.¹

Stimulant Vs. Non-stimulant Medications for ADHD

When it comes to ADHD treatment, there are two main categories of medications: stimulants and non-stimulants. Stimulant medications, such as Adderall and Ritalin, are known for their effectiveness as ADHD treatments. Because of this, they are considered first-line treatments for ADHD symptoms. Clonidine, on the other hand, is classified as a non-stimulant medication and is often used as a second-line or additional treatment for ADHD when stimulants are not suitable or do not provide the desired results.

Stimulant medications work by increasing the levels of certain chemicals in the brain that regulate attention and impulse control.² They have a rapid onset of action and are generally effective in reducing ADHD symptoms. However, some individuals may experience side effects or have other risks or conditions that may prevent them from using stimulant medications. In these cases, non-stimulant options like clonidine are considered.

Clonidine acts differently by targeting specific receptors in the brain, resulting in a calming effect and improved attention. While it may not be as commonly prescribed as stimulants, clonidine can be a valuable alternative for those who cannot or prefer not to use stimulant medications. Your healthcare provider can help determine the most appropriate treatment approach for your unique situation.

How Does Clonidine Help ADHD?

Clonidine affects the part of the brain that regulates attention and impulse control. Extended-release clonidine tablets are FDA-approved for ADHD treatment. Clonidine comes under the brand name Kapvay, which is also FDA-approved for ADHD. Clonidine is also available in other forms that are FDA-approved to treat hypertension, but not ADHD. It is available as an immediate release tablet and as a transdermal patch (Catapres-TTS) as well as an extended-release brand name Nexiclon XR, all approved for hypertension. Clonidine is also available as an injection that is used to treat severe pain.

In ADHD treatment, clonidine is believed to work by stimulating alpha-2 adrenergic receptors in the brain. This stimulation helps regulate the release of norepinephrine, a neurotransmitter involved in attention and impulse control.² By affecting the activity of these receptors, clonidine can help improve focus, reduce hyperactivity, and manage impulsivity in individuals with ADHD. Its effectiveness and safety have been demonstrated in clinical studies.²

Who Can Take Clonidine for ADHD?

Clonidine can be prescribed to children who are at least 6 years of age, adolescents, and adults with ADHD. While it is more commonly used for children, it can also be considered for adult ADHD treatment.¹ The decision to prescribe clonidine for ADHD may depend on various factors, including the individual’s medical history, response to other treatments, and the clinician’s judgment.

Pros & Cons of Using Clonidine for ADHD

Clonidine offers both advantages and disadvantages when used for ADHD treatment. On the positive side, it can be an effective alternative for individuals who cannot tolerate or do not respond well to stimulant medications. Clonidine may also help manage ADHD symptoms, such as impulsivity and hyperactivity. However, it’s important to consider potential drawbacks, including side effects, each person’s unique response, and that it may not be as effective of a treatment for ADHD as first-line treatments.¹

Pros Using Clonidine

Clonidine may be used as an alternative treatment for those who may not be able to take stimulant medications. Clonidine may be particularly helpful for impulsivity and hyperactivity symptoms. Additionally, clonidine can be used in combination with other ADHD treatments, such as behavioral therapies. Some individuals find that clonidine has a calming effect, which may help address sleep difficulties often associated with ADHD.

Cons of Using Clonidine

While clonidine can be effective for some individuals, it is important to be aware of potential side effects. These can include dizziness, dry mouth, and sedation, which may impact daily functioning. Individual responses to clonidine can vary, and it may not be as effective as stimulant medications for everyone.

Also, clonidine is not considered a first-line treatment option for ADHD and is typically used when other approaches have been explored. Close monitoring and adjustment of dosage are necessary to ensure optimal benefits and minimize potential risks. It is essential to discuss the pros and cons of clonidine with your healthcare provider to determine if it is the right choice for your specific situation.

Clonidine Dosage for ADHD

The dosage of clonidine for ADHD varies based on several factors, including age, individual response, and the specific formulation prescribed. It is important to follow the prescribing clinician’s instructions closely. Doses of clonidine higher than 0.4 mg/day (0.2 mg twice daily) were not evaluated in clinical trials for ADHD and are not recommended.¹

Here are the available dosages for extended-release clonidine:

• 0.1 mg tablets

How to Take Clonidine for ADHD

Clonidine is usually taken orally, with or without food. Do not crush, chew, or break the tablets before swallowing.¹ It is usually taken twice per day, once in the morning and once at bedtime.

Your dose may be lower to start with, increasing gradually until symptoms improve and can be maintained. The dosage and frequency will depend on your needs and your response to the medication. Your prescriber will closely monitor you throughout this process until the dosage is at the right level for you.

Clonidine Side Effects

Clonidine, like any medication, can cause side effects. Side effects are possible because medications like clonidine interact with various systems and processes in the body. The specific side effects experienced can vary among individuals. Common side effects of clonidine include drowsiness, dry mouth, dizziness, constipation, and sedation. These side effects may occur due to the medication’s effects on the central nervous system and the regulation of blood pressure. ¹

Mild side effects include:

• Dizziness
• Tiredness
• Cough
• Irritability
• Insomnia
• Change in mood
• Constipation
• Dry mouth
• Decreased appetite

Severe side effects that require immediate medical attention include:

• Difficulty breathing
• Hallucinations
• Severe drowsiness
• Decreased heart rate
• Decreased blood pressure

While many people tolerate clonidine well, some individuals may experience more severe side effects or allergic reactions. This is not a comprehensive list of side effects possible with clonidine and it is important to talk with your doctor about the potential risks of this medication.

It is also important to be aware of the potential side effects and promptly report any concerning symptoms to your healthcare provider. They can assess the severity of the side effects, determine if any adjustments to the medication are necessary, and provide appropriate medical care if needed. It is always better to seek medical advice if you have any concerns or experience side effects that significantly impact your well-being or daily functioning.

How Long Does Clonidine Take to Work?

Clonidine will start working within a few hours of taking your first dose, but it may take time for you to notice a change in your symptoms. It is important to set realistic expectations and understand that the time it takes for a medication to start working can vary from person to person. While some individuals may notice improvements in their ADHD symptoms within a few days of starting clonidine, others may require several weeks before noticing the benefits.

The dosage prescribed, individual response to the medication, and the presence of any coexisting conditions can all affect the time it takes for clonidine to work. It is crucial to maintain open communication with your healthcare provider throughout the treatment process to monitor progress and make any necessary adjustments. Remember to follow your doctor’s guidance and be patient as you work together to find the most effective approach for managing your ADHD symptoms.

Clonidine Warnings & Precautions

While generally considered safe and effective when used as directed, clonidine carries certain warnings and precautions. Some situations may require immediate medical attention or special consideration.

Warnings and precautions for taking clonidine include:

• Decreased blood pressure and heart rate: Clonidine can cause low blood pressure and a slow heart rate. It is possible that this change can lead to serious side effects, particularly if you have certain conditions with your heart. Talk with your healthcare provider about monitoring your blood pressure while taking clonidine.
• Heart conditions: Clonidine should be used with caution in individuals with pre-existing heart conditions, such as heart rhythm disorders or a history of heart attacks. It is important to discuss your medical history with your healthcare provider to ensure clonidine is appropriate for you.
• Central nervous system depression: Clonidine can have sedative effects and may cause drowsiness or impaired cognitive function. It is important to use caution when operating machinery or engaging in activities that require alertness until you know how clonidine affects you.²
• Pregnancy: It is essential to discuss the use of ADHD medications, including clonidine, with your healthcare provider if you are pregnant or planning to become pregnant. They can provide guidance on potential risks and benefits.
• Pediatric use: Clonidine use in children and adolescents requires careful monitoring and adjustment of dosage. It should only be used under the supervision of a healthcare provider experienced in treating pediatric patients with ADHD and it is only approved for children aged 6 years old and older.

Clonidine Withdrawal Symptoms

When stopping clonidine abruptly, withdrawal symptoms may occur. These symptoms can vary in prevalence and severity among individuals. Factors such as age, dosage, and duration of use may influence the likelihood and intensity of withdrawal symptoms. Common withdrawal symptoms include rebound hypertension, nervousness, agitation, and sleep disturbances. If you are considering discontinuing clonidine, it is crucial to work with your healthcare provider to taper the dosage gradually.¹

Drug Interactions with Clonidine

Disclaimer: Taking certain medications, herbs, or supplements alongside clonidine can change how clonidine works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Clonidine can interact with certain medications, herbs, or supplements, potentially altering its effectiveness or increasing the risk of side effects. It is important to inform your healthcare provider about all the products you are using. Here are some medications that can negatively interact with clonidine.

Medications that can negatively interact with clonidine include:

1. Tricyclic antidepressants (TCAs): Using TCAs and clonidine at the same time may increase the risk of low blood pressure and drowsiness. Close monitoring and potential dosage adjustment may be needed.
2. Beta-blockers: Combining beta-blockers with clonidine can lead to additive effects on reducing blood pressure and heart rate. Close medical monitoring is recommended to limit these risks.
3. Calcium channel blockers: Using calcium channel blockers and clonidine at the same time may also result in additive hypotensive effects. Careful monitoring of blood pressure and heart rate is advised to reduce these risks.
4. Sedatives and hypnotics: Combining sedatives or hypnotics with clonidine can potentiate central nervous system depression, leading to increased sedation and respiratory depression. Use these medications with caution. It may be necessary to stop using them together or adjust the dosages to reduce risk.
5. Medications that have a sympatholytic action: Medications that have sympatholytic actions have an effect on the central nervous system and can cause dangerous heart conditions when taken with clonidine. Examples of these medications include tamsulosin and prazosin.

How to Get a Prescription for Clonidine

To get a prescription for clonidine, it is necessary to consult with a healthcare provider, such as a doctor or psychiatrist, who specializes in ADHD treatment. They will assess your symptoms, medical history, and other relevant factors to determine if clonidine is an appropriate treatment option for you. Online psychiatry services can also provide evaluation and prescription services for individuals seeking ADHD treatment.

Alternative Treatments for ADHD

In addition to clonidine, there are various alternative treatments available for ADHD. These include other medications, therapy approaches, lifestyle changes, and self-help strategies. Other medications commonly used for ADHD include stimulant medications like Adderall and non-stimulant medications like atomoxetine.

Therapy options may include cognitive-behavioral therapy (CBT) for ADHD or participation in online group therapy or support groups. It is important to discuss these alternatives with your healthcare provider to determine the most suitable approach for your specific needs.

Questions to Ask Your Healthcare Provider About Clonidine for ADHD

When considering clonidine for ADHD treatment, it is important to have open and informed discussions with your healthcare provider. Here are some important questions to ask your doctor or psychiatrist:

• Can I use clonidine along with therapy to treat ADHD?
• How long will it take for me to adjust to taking clonidine?
• Am I at risk for more severe symptoms if I am already taking other medications, such as for anxiety or depression?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions with clonidine?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• Will this affect my current hypertension regimen?
• Are there any lifestyle modifications or dietary restrictions I should be aware of while taking clonidine?
• How often will I need to follow up with you to monitor the effectiveness and safety of clonidine?
• Are there any complementary therapies I should consider alongside clonidine?
• Can clonidine be used in combination with other ADHD medications if needed?

In My Experience

In my experience as a hospital pharmacist, clonidine can be a valuable treatment option for individuals with ADHD, especially when stimulant medications are not suitable or well-tolerated. It can help manage symptoms such as impulsivity, hyperactivity, and aggression.

If you are considering clonidine or have been prescribed it for ADHD, my advice is to stay active in your treatment journey. Be sure to communicate any concerns, side effects, or changes in symptoms to your healthcare provider. They can help adjust dosages, explore alternative treatments if necessary, and ensure that you receive the best possible care.

Lastly, remember that ADHD is a complex condition, and each individual’s experience is unique. Don’t hesitate to seek support from professionals, ADHD support groups, and reputable resources to gain a deeper understanding of the condition and connect with a community that can provide valuable insights and encouragement.

Ultimately, finding the right approach to manage ADHD requires a collaborative effort between you, your doctor, and your support network. By being proactive and staying informed, you can navigate your ADHD journey with confidence and work towards achieving your goals and well-being.

For Further Reading

• ADHD Medication Side Effects: Everything You Need to Know – Choosing Therapy
• ADHD Medication for Kids: Types, Side Effects, & Risks
• Adult ADHD Medication: Types, Side Effects & Risks
• Adderall Weight Loss: Risks and What You Need To Know
• Ritalin Withdrawal: Symptoms, Timeline, & Treatment
• ADDA (Attention Deficit Disorder Association)