Have you ever heard of a medication that has several different uses so unlike one another it seems impossible? Well, this is what the medication clonidine brings to the table! Clonidine is used to treat high blood pressure, attention deficit/hyperactivity disorder (ADHD), and pain management. It also helps in the diagnosis of growth hormone deficiency and can be used for smoking cessation therapy in adults.
This is a very fascinating concept to me and one of the reasons why I chose clonidine as the topic of this discussion. The other reason is because an extended-release form of clonidine has recently been approved and will be promoted to help in the treatment of ADHD. Instead of focusing on this new medication called Kapvay (extended-release clonidine), we’re going to stick with the old and learn about the role immediate-release clonidine has in treating ADHD. This will allow us to compare the older version of clonidine to the new extended-release form in our next discussion.
Indications
Clonidine has FDA approval for all the conditions mentioned above except for the treatment of ADHD and nicotine withdrawal symptoms in adults, which means it is used as off-label treatments for these purposes. Clonidine is generally used as either an alternative or an add-on to other medications for the treatment of ADHD, so it’s not the top choice for this condition.
Other off-label or investigational uses include alcohol dependence, heroin withdrawal, vasomotor symptoms due to menopause (i.e. hot flashes), diabetes-associated diarrhea, painful menstrual cycles, and the prevention of migraines. Obviously some of these uses are not so kid specific, but it just goes to show how unique clonidine is with all of its potential roles in the medical field!
Clonidine is available by prescription only in the form of a tablet, transdermal patch, or injection for epidural administration. The tablet form is generally used for ADHD treatment and the epidural is the dosage form used for pain management.
How the drug works
Clonidine is a central alpha-2-adrenergic agonist that decreases the release of norepinephrine from nerve cells in the brain. Norepinephrine is a chemical that naturally occurs in the nervous system. When the release of this chemical is decreased, the firing rate of nerve cells is reduced within a specific part of the brain that is responsible for arousal, thereby decreasing excessive stimulation found in patients with ADHD.
Side effects and precautions
Even though clonidine is intriguing in its ability to serve many purposes, it does not come without warning. The American Heart Association recommends that all children should get a thorough cardiovascular exam before initiating clonidine therapy. This recommendation is based on reports of serious cardiovascular adverse events in both children and adults who were also taking normal doses of stimulant medications. Most of these affected patients had underlying structural heart disease. Examples of stimulant medications include methylphenidate, dextroamphetamine, and mixed amphetamine salts (i.e. Adderall), which are considered the first-line treatment of ADHD.
Clonidine therapy should not be abruptly discontinued because your child may experience a rapid increase in blood pressure and overactivity of the central nervous system, which includes increased heart rate, palpitations, tremors, anxiety, agitation, insomnia, and sweating. If your child needs to stop taking oral clonidine, they should be tapered off the tablet gradually over more than 1 week.
Other side effects of clonidine your child may experience include decreased heart rate, decreased blood pressure, sedation, depression, constipation, dry mouth, dry eyes and headache. Also, dosing adjustment may be needed in children with kidney disease.
Similar medications
Guanfacine is also a central alpha-2-adrenergic agonist that is commonly used as an alternative or add-on treatment for ADHD. It actually may be a better option for your child as it stays in the body longer and has fewer side effects than clonidine. There is also an extended-release guanfacine (Intuniv) on the market that is approved for children and adolescents aged 6 to 17 years for once-daily treatment of ADHD.
Administration guidelines
All things considered, clonidine therapy is pretty straightforward. The tablet can be given with or without food, but if it seems to be bothering your child’s stomach, giving it with food is advisable.
When your child is started on clonidine treatment, their dose should be initiated on the low side and then gradually increased every 3 to 7 days until the target dose is reached. Doses are usually given 3 to 4 times per day. If a dose is missed, give your child the missed dose as soon as possible. If it is almost time for your child’s next dose, skip the missed dose and return to their regular dosing schedule. Definitely do not give them a double dose!
Recommendations
Clonidine is a less effective option than the stimulant medications for single drug therapy of ADHD, but it is being more frequently prescribed as an add-on to control aggression or to improve sleep. This means you may want to reserve clonidine as an alternative if the stimulant medications are not tolerable or as an add-on if more control of an overaroused, highly active, more aggressive, or easily frustrated child is needed. I would even go a step further by choosing guanfacine over clonidine because it has fewer side effects and because it has the potential of being dosed fewer times per day.
If your child is started on clonidine and complains of dry eyes, you may offer them relief by giving them artificial tears. Constipation may be avoided by giving them a diet high in fiber, having them drink more liquids, and keeping them active. Lastly, dry mouth may cause cavities so help your child take good care of their teeth and be sure they see a dentist on a regular basis.
Any questions, comments, or concerns? Let us know by leaving a comment below or e-mail me at Cate@getpharmacyadvice.com.
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