AdultPediatricGeriatricDosage Forms & Strengths injectable solution 100mcg/mL 500mcg/mL patch, extended-release 0.1mg/day 0.2mg/day 0.3mg/day tablet, immediate-release 0.1mg 0.2mg 0.3mg tablet, extended-release 0.1mg Hypertension Immediate-release tablets 0.1 mg PO q12hr Range: 0.1-0.2 mg/day q12hr; not to exceed 2.4 mg/day Transdermal Apply 1 patch q7Days; start with 0.1 mg; increase by 0.1 mg after q1-2Week interval; usual dose range is 0.1-0.3 mg qWeek Cancer Pain Epidural infusion Severe pain in patients with cancer not adequately relieved by opioid analgesics alone Initial: 30 mcg/hr Titrate as required for pain relief or presence of side effects Limited data on doses exceeding 40 mcg/hr Dosing considerations Epidural administration (Duraclon) is indicated in combination with opiates for the treatment of severe pain in patients with cancer not adequately relieved by opioid analgesics alone More likely to be effective in patients with neuropathic pain than in those with somatic or visceral pain Safety and effectiveness of epidural administration in this limited indication and clinical population have been established in patients old enough to tolerate placement and management of an epidural catheter; these conclusions are based on evidence from adequate and well-controlled studies in adults and through experience with the use of clonidine in the pediatric age group for other indications Acute Hypertension (Off-label) 0.1-0.2 mg PO; may follow with additional doses of 0.1 mg qhr PRN to maximum 0.6 mg total dose EtOH Withdrawal (Off-label) 0.3-0.6 mg PO q6hr Smoking Cessation (Off-label) PO administration: 0.1 mg qDay; increase by 0.1 mg/day to 0.15-0.75 mg/day if required TD administration: 100-200 mcg/day patch q7Days Restless Legs Syndrome (Off-label) 100-300 mcg PO 2 hours befor bedtime, up to 900 mcg/day Tourette's Syndrome (Off-label) 0.0025-0.015 mg/kg/day PO for 6 weeks to 3 months Cyclosporine Nephrotoxicity (Off-label) 100-200 mcg/day transdermal patch; change q7Days Menopausal Flushing (Off-label) Apply 100 mcg/day patch; change q7Days, OR 50 mcg PO q12hr initially; may increase up to 400 mcg q12hr Dysmenorrhea (Off-label) PO administration: 0.025 mg q12hr for 2 weeks prior to menstruation Opioid Withdrawal (Off-label) PO administration: 0.1-0.3 mg q4-6hr; increase by 0.1 mg/day to 0.15-0.75 mg/day if required; do not exceed 2.4 mg/day TD administration: 100-200 mcg/day patch q7Days; initiate 0.1-0.3 mg PO q4-6hr for first 2 days to allow for adequate drug levels Postherpetic Neuralgia (Off-label) PO administration: 0.1 mg q12hr Psychosis (Off-label) PO administration: 0.4-1.4 mg/day in divided doses Pheochromocytoma Diagnosis (Off-label) Clonidine suppression testing: 0.3 mg PO for 60-80 kg patient; obtain blood sample 3 hours after administration to supine patient Dosing Considerations Extended-release is not to be used interchangeably with immediate-release tablets Dosing Modifications Renal Impairment Impact of renal impairment not assessed Initial dose adjustment should be based on amount of renal impairment Monitor carefully for hypotension and bradycardia Removed minimally during hemodialysis; no need to redose following dialysis Dosage Forms & Strengths injectable solution 100mcg/mL 500mcg/mL patch 0.1mg/day 0.2mg/day 0.3mg/day tablet, immediate-release 0.1mg 0.2mg 0.3mg tablet, extended-release 0.1mg Hypertension >12 years old Immediate-release tablets: 0.2 mg/day PO divided q12hr; increase qWeek; maintenance dose range, 0.2-0.6 mg/day q12hr; not to exceed 2.4 mg/day Transdermal patch: 0.1 mg patch q7Day initially; may increase by weekly 0.1-mg increments after 1-2 weeks if desired blood pressure reduction not achieved; not to exceed 0.6 mg/week (ie, 2 clonidine 0.3 mg patches) <12 years old Immediate-release tablets and transdermal patch: Safety and efficacy not established ADHD <6 years old: Not established ≥6 years old (extended-release tablets, Kapvay): 0.1 mg PO qHS initially; may adjust dose by increments of 0.1 mg/day at weekly intervals until desired response; not to exceed 0.4 mg/day When discontinuing, taper gradually by decrements not to exceed 0.1 mg q3-7Days Dosing considerations May be given as monotherapy or as adjunctive therapy with stimulants Extended-release not interchangeable with immediate-release product Cancer Pain Severe pain in patients with cancer not adequately relieved by opioid analgesics alone Epidural infusion: 0.5 mcg/kg/hr initially; adjust according to clinical response Dosing considerations Epidural administration (Duraclon) is indicated in combination with opiates for the treatment of severe pain in patients with cancer not adequately relieved by opioid analgesics alone Restrict use to pediatric patients with severe, intractable pain from malignancy that is unresponsive to epidural or spinal opiates or to other, more conventional analgesic techniques More likely to be effective in patients with neuropathic pain than in those with somatic or visceral pain Safety and effectiveness of epidural administration in this limited indication and clinical population have been established in patients old enough to tolerate placement and management of an epidural catheter; these conclusions are based on evidence from adequate and well-controlled studies in adults and through experience with the use of clonidine in the pediatric age group for other indications Dosing Modifications Renal Impairment Impact of renal impairment not assessed Initial dose adjustment should be based on amount of impairment Monitor carefully for hypotension and bradycardia Removed minimally during hemodialysis, so no need to redose following dialysis Hypertension Immediate-release tablets: 0.1 mg PO qHS Dosing considerations Not recommended as routine treatment for hypertension (Beers criteria) Potential for orthostatic hypotension and adverse CNS effects May cause bradycardia Immediate release: Lower initial doses than for nongeriatric adult dosing, as well as gradual adjustments, are recommended Extended release: May require lower initial dose than for nongeriatric adult dosingInteraction CheckerEnter a drug name and clonidineNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (71)adagrasibadagrasib will increase the level or effect of clonidine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a P-gp inhibitor, with sensitive P-gp substrates unless otherwise recommended in the prescribing information for these substrates.alfentanilclonidine, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.amitriptylineamitriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.amoxapineamoxapine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.atenololclonidine, atenolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.azelastineclonidine, azelastine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced CNS depressant effects.betaxololclonidine, betaxolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.bisoprololclonidine, bisoprolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.bremelanotidebremelanotide will decrease the level or effect of clonidine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.brigatinibbrigatinib will decrease the level or effect of clonidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.buprenorphineclonidine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.buprenorphine buccalclonidine, buprenorphine buccal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.buprenorphine subdermal implantclonidine, buprenorphine subdermal implant. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.buprenorphine transdermalclonidine, buprenorphine transdermal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.buprenorphine, long-acting injectionclonidine, buprenorphine, long-acting injection. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.butorphanolclonidine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.calcium/magnesium/potassium/sodium oxybatesclonidine, calcium/magnesium/potassium/sodium oxybates. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.clomipramineclomipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.codeineclonidine, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.desipraminedesipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.diltiazemclonidine, diltiazem. unknown mechanism. Avoid or Use Alternate Drug. Reports of sinus bradycardia resulting in hospitalization and pacemaker insertion reported with concomitant use. Possible life-threatening effect, monitor closely.doxepindoxepin decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.esmololclonidine, esmolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.ethanolclonidine, ethanol. Either increases toxicity of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.hydrocodoneclonidine, hydrocodone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.hydromorphoneclonidine, hydromorphone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.imipramineimipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.iobenguane I 131clonidine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.levobunololclonidine, levobunolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.lofepraminelofepramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.lofexidinelofexidine, clonidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.lumacaftor/ivacaftorlumacaftor/ivacaftor will decrease the level or effect of clonidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.macimorelinclonidine, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may transiently elevate growth hormone (GH) concentrations may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.maprotilinemaprotiline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.meperidineclonidine, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.methadoneclonidine, methadone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.metoclopramide intranasalclonidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.metoprololclonidine, metoprolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.mirtazapinemirtazapine decreases effects of clonidine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of hypertensive urgency.mobocertinibmobocertinib will decrease the level or effect of clonidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.morphineclonidine, morphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.nadololclonidine, nadolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.nalbuphineclonidine, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism.