Clonidine

• Alpha-2 receptor agonist - activates receptors that calm the nervous system
• Reduces norepinephrine release - decreases stress hormone activity
• Central nervous system effects - works in the brain to reduce hyperarousal
• Sympathetic nervous system suppression - calms fight-or-flight response
• Multiple neurotransmitter effects - affects norepinephrine, dopamine, and other systems

In Mental Health: Clonidine helps calm an overactive nervous system, which is beneficial for conditions involving hyperarousal, impulsivity, or excessive stress response. It can reduce symptoms like hyperactivity, impulsiveness, aggression, and anxiety by dampening the brain's alarm system.

• Hyperactivity - reduces excessive movement and restlessness
• Impulsivity - helps with impulse control
• Aggression - calms aggressive behaviours
• Sleep problems - helps children with ADHD fall asleep
• Combination therapy - often used with stimulants

Anxiety and Trauma:

• PTSD symptoms - reduces hyperarousal and startle response
• Panic attacks - can help with physical symptoms
• Performance anxiety - reduces physical symptoms of nervousness
• Sleep disturbances - helps with trauma-related insomnia
• Hypervigilance - reduces excessive alertness

Substance Use Disorders:

• Opioid withdrawal - reduces withdrawal symptoms
• Alcohol withdrawal - helps with anxiety and agitation
• Nicotine cessation - may reduce cravings and withdrawal
• Cocaine withdrawal - helps with some withdrawal symptoms

Other Mental Health Uses:

• Tourette syndrome - reduces tics in some people
• Autism spectrum disorders - helps with hyperactivity and aggression
• Conduct disorder - reduces aggressive behaviours
• Sleep disorders - particularly in children

• May feel drowsy or tired initially
• Blood pressure and heart rate may decrease
• Some people notice calming effects quickly
• Take as prescribed, usually 2-3 times daily
• Side effects often improve with time

First Few Weeks:

• Gradual improvement in target symptoms
• Dose may be adjusted based on response
• Side effects typically decrease
• Important to take consistently
• Regular monitoring by healthcare provider

Long-term Use:

• Sustained improvement in symptoms
• Regular blood pressure and heart rate monitoring
• Periodic review of continued need
• Generally well-tolerated for extended periods
• May allow for better functioning in daily activities

• Reduces hyperactivity - less restlessness and fidgeting
• Improves impulse control - better ability to think before acting
• Calms aggression - less aggressive or oppositional behaviour
• Helps sleep - easier time falling asleep and staying asleep
• Complements stimulants - can be used together for better control

For Anxiety and PTSD:

• Reduces physical symptoms - less racing heart, sweating, trembling
• Calms hyperarousal - less excessive alertness and startle response
• Improves sleep - better sleep quality and less nightmares
• Reduces panic - fewer and less intense panic attacks
• Enhances therapy - calmer state allows better engagement in treatment

For Substance Withdrawal:

• Reduces withdrawal symptoms - less anxiety, agitation, and physical discomfort
• Prevents complications - reduces risk of seizures in alcohol withdrawal
• Improves comfort - makes withdrawal more tolerable
• Supports recovery - helps people get through difficult withdrawal period

• Drowsiness - most common, especially initially
• Dry mouth - reduced saliva production
• Dizziness - particularly when standing up
• Fatigue - feeling tired or low energy
• Constipation - reduced bowel movement frequency
• Headache - usually mild and temporary

Cardiovascular Effects:

• Low blood pressure - can cause dizziness and fainting
• Slow heart rate - bradycardia
• Rebound hypertension - if stopped suddenly
• Orthostatic hypotension - dizziness when standing

Serious Risks:

• Rebound hypertension - dangerous blood pressure spike if stopped suddenly
• Severe hypotension - dangerously low blood pressure
• Cardiac arrhythmias - irregular heart rhythms
• Withdrawal syndrome - if discontinued abruptly
• Depression - mood changes in some people

• Blood pressure and heart rate measurement
• Review of all medications, especially heart medications
• Assessment of heart conditions and circulation problems
• Discussion of depression or mood disorder history
• Evaluation of kidney function

While Taking:

• Never stop suddenly - must taper gradually
• Monitor blood pressure and heart rate regularly
• Rise slowly from sitting or lying positions
• Stay well-hydrated
• Avoid alcohol, which can worsen side effects
• Be careful in hot weather or with exercise

Special Populations:

• Children - commonly used, requires careful dosing and monitoring
• Elderly - higher risk of falls due to dizziness
• Heart disease - careful monitoring required
• Kidney disease - dose adjustment may be necessary
• Pregnancy - discuss risks and benefits with doctor

• Other blood pressure medications - can cause excessive blood pressure lowering
• Beta-blockers - can worsen rebound hypertension if clonidine stopped
• Tricyclic antidepressants - can reduce clonidine effectiveness
• Alcohol - increases sedation and blood pressure effects
• CNS depressants - increased drowsiness and sedation

Medications to Monitor:

• Heart medications - digoxin, calcium channel blockers
• Diabetes medications - clonidine may affect blood sugar
• Sedatives - increased drowsiness risk
• Pain medications - opioids can increase sedation

• Adults - usually 0.1mg twice daily
• Children - weight-based dosing, typically lower
• Take with or without food
• Divide total daily dose into 2-3 smaller doses

Dose Adjustment:

• Increase gradually every few days to weeks
• Typical range - 0.1-0.8mg daily in divided doses
• Maximum dose - varies by condition and individual
• Adjust based on symptom improvement and side effects
• Individual variation in effective dose

Patch Formulation:

• Catapres-TTS - weekly patch application
• Provides steady medication levels
• Good for people who forget oral doses
• May cause skin irritation at patch site
• Takes longer to reach steady levels

• Never stop suddenly - can cause dangerous rebound hypertension
• Reduce dose slowly over 1-2 weeks or longer
• Work with healthcare provider for tapering schedule
• Monitor blood pressure closely during tapering
• May need to restart if severe rebound occurs

Withdrawal/Rebound Symptoms:

• Rebound hypertension - blood pressure spike (most dangerous)
• Anxiety and agitation - return of original symptoms
• Rapid heart rate - tachycardia
• Headache - often severe
• Nausea and vomiting - stomach upset
• Insomnia - difficulty sleeping

• Blood pressure and heart rate checks
• Assessment of target symptoms (ADHD, anxiety, etc.)
• Evaluation of side effects and tolerability
• Review of other medications and interactions
• Periodic review of continued need

What to Track:

• Symptom improvement - hyperactivity, anxiety, sleep
• Side effects - drowsiness, dizziness, dry mouth
• Blood pressure - if monitoring at home
• Heart rate - especially if history of heart problems
• Mood changes - watch for depression

When to Contact Provider:

• Severe dizziness or fainting
• Very low blood pressure or heart rate
• Worsening depression or mood changes
• Severe side effects
• Need to stop medication for any reason

• ADHD - effective for hyperactivity and impulsivity, especially in children
• PTSD - helps with hyperarousal symptoms
• Substance withdrawal - reduces withdrawal symptoms
• Tourette syndrome - can reduce tics
• Generally well-tolerated in appropriate doses

Research Findings:

• Effective for ADHD symptoms, particularly hyperactivity
• Helpful for sleep problems in children with ADHD
• Reduces withdrawal symptoms in opioid and alcohol dependence
• May help with PTSD-related hyperarousal
• Can be safely combined with stimulants for ADHD

• Generic clonidine widely available and inexpensive
• Insurance typically covers for approved uses
• May require prior authorisation for some off-label uses
• Patient assistance programs available if needed

Typical Costs:

• Generic clonidine tablets: $10-30 per month
• Clonidine patches: $50-100 per month
• Costs vary by dose, formulation, and pharmacy
• Usually very affordable medication

• Stimulant medications - methylphenidate, amphetamines
• Non-stimulant ADHD medications - atomoxetine, guanfacine
• Behavioural therapy - behaviour modification techniques
• Lifestyle changes - exercise, sleep hygiene, diet

For Anxiety/PTSD:

• Antidepressants - SSRIs, SNRIs
• Anti-anxiety medications - buspirone, benzodiazepines
• Therapy - CBT, EMDR, exposure therapy
• Other medications - prazosin, gabapentin

For Substance Withdrawal:

• Specific withdrawal medications - buprenorphine for opioids
• Benzodiazepines - for alcohol withdrawal
• Supportive care - hydration, nutrition, monitoring
• Behavioural support - counselling, support groups