Clonidine ER
Generic: clonidine hydrochloride extended-release · Brand: Kapvay® · Class: Non-Stimulant — Alpha-2 Agonist
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How It Works
Clonidine extended-release is a non-stimulant alpha-2 adrenergic agonist similar in mechanism to guanfacine but with less receptor selectivity. It activates alpha-2 receptors in the prefrontal cortex and locus coeruleus, reducing hyperactivity and impulsivity without stimulant effects. Clonidine is more sedating than guanfacine, which can be both a side effect and a benefit — it is frequently used for ADHD-related sleep difficulties. It is also used for tics, aggression, and as an adjunct to stimulants. Originally an antihypertensive medication, it lowers blood pressure and heart rate.
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What It Treats
ADHD in Children 6–17FDA-approved as Kapvay for ADHD monotherapy or adjunct to stimulants
ADHD with Sleep DifficultiesThe sedating effect is often used therapeutically for ADHD-related insomnia
ADHD with TicsWell-established for tic reduction in Tourette syndrome and ADHD+tics
Stimulant AugmentationCommonly added to stimulants when sleep or hyperactivity remain problematic
ADHD with AggressionEffective for emotional dysregulation and aggressive behaviors in children
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Children 6–17 ADHD | 0.1 mg at bedtime | 0.1–0.4 mg/day | 0.4 mg/day |
| Children 6–17 Split dosing | 0.1 mg twice daily | 0.2–0.4 mg/day | 0.4 mg/day |
| Adults Off-label | 0.1 mg at bedtime | 0.1–0.3 mg/day | 0.4 mg/day |
Kapvay ER taken twice daily (morning and bedtime). Do not crush or chew. Do not take with high-fat meals. Taper slowly when stopping — never stop abruptly due to rebound hypertension risk. Immediate-release clonidine is different from Kapvay ER.
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Side Effects
Common
- Significant sedation (most common)
- Low blood pressure / dizziness
- Dry mouth
- Fatigue
- Constipation
- Decreased heart rate
- Headache
- Irritability
Call us if you notice
- Significant blood pressure drop (fainting)
- Very slow heart rate
- Severe sedation
- Rebound hypertension if stopped abruptly
- Allergic skin reaction
Clonidine is more sedating than guanfacine — bedtime dosing is particularly useful for sleep problems associated with ADHD or stimulant use. Never stop abruptly. Monitor blood pressure at home if possible. Drowsiness usually improves after the first 1–2 weeks.
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Tips for Success
Bedtime DoseThe bedtime dose helps with ADHD-related sleep difficulties — use this to your advantage.
Check Blood PressureMonitor blood pressure at home regularly — clonidine lowers it significantly.
Don't Stop AbruptlyAlways taper slowly — rebound high blood pressure can be dangerous.
Rise SlowlyStand up slowly from sitting or lying to prevent dizziness and falls.
Sedation ImprovesDrowsiness usually improves significantly after the first 1–2 weeks.
Tell All ProvidersInteracts with blood pressure medications and other CNS depressants.
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Important Safety Information
Blood Pressure Warning: Clonidine significantly lowers blood pressure and heart rate. Check BP regularly. Rise slowly to avoid fainting. Tell your provider about any heart or blood pressure conditions.
Do Not Stop Abruptly — IMPORTANT: Stopping clonidine suddenly can cause dangerous rebound hypertension (severe spike in blood pressure). This is a medical risk. Always taper slowly under your provider guidance.
Sedation — Use Caution: Clonidine causes significant drowsiness. Do not drive or operate machinery until you know how it affects you. Alcohol dramatically worsens sedation.
Do Not Confuse Formulations: Kapvay (extended-release) is different from immediate-release clonidine. Do not substitute one for the other without provider guidance.
Pregnancy: Discuss risks and benefits with your provider.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com