Clonidine for ADHD Treatment: What to Know

Medically reviewed by Lindsay Cook, PharmD

Historically, the centrally acting alpha-agonist hypotensive agent, prescription-based clonidine, has primarily treated hypertension (high blood pressure).

However, in 2010, the Food and Drug Administration (FDA) approved clonidine for managing the symptoms of attention deficit hyperactivity disorder (ADHD).

Clonidine is now a widely used effective treatment for the management of ADHD alone or as a combination therapy. Clonidine has been reported to be well tolerated with fewer side effects than other central nervous system (stimulant and non-stimulant) drugs.

Though availability may vary based on brand-name versus generic options, clonidine is available for administration as an immediate-release (IR) tablet, an extended-release (ER) tablet, a transdermal patch, and an intravenous (IV) injectable.

Read on for an in-depth analysis of clonidine and its ability to manage symptoms of ADHD.

What Are Centrally Acting Alpha-Agonist Hypotensive Agents?

Alpha receptor agonists have treated various conditions for decades. These conditions include high blood pressure, ADHD, panic disorders, symptoms of opioid withdrawal, symptoms of alcohol withdrawal, and cigarette cessation.

Alpha-receptor agonist drugs stimulate alpha-adrenoceptors in the brain to decrease the heart rate and relax the blood vessels so blood can flow more quickly through the body stem to reduce hypertension.

Centrally acting medications are beneficial in people with high blood pressure who do not respond or give the required results with other antihypertensive medications.

Clonidine is also often used in the perioperative setting to control high blood pressure while also providing an anesthetic and analgesic (painkilling) effect.

Beyond clonidine, commonly administered centrally acting alpha-agonist hypotensive agents include generic methyldopa and Intuniv ER (guanfacine). 

What Is Clonidine?

Clonidine is FDA-approved for use alone or in combination with other medications to treat high blood pressure in adults and children who are 6 years old and older.

However, in recent decades, clonidine has treated a steadily expanding number of conditions.

The following will discuss dosing forms, FDA-approved uses, off-label uses, and brand-name versions of clonidine.

Uses

As previously discussed, clonidine is available for administration as an immediate-release (IR) tablet, an extended-release (ER) tablet, a transdermal patch, and an intravenous (IV) injectable.

The FDA has also approved an ER tablet form of clonidine (brand name: Kapvay) to manage the symptoms of ADHD in combination with other medicines, such as stimulants, or as part of a treatment program to manage ADHD-related symptoms.

Conversely, healthcare providers typically use clonidine IR tablets to treat high blood pressure.

Alongside opiates, the IV injection form of clonidine treats severe pain in people with cancer that opioids cannot adequately relieve alone.

Finally, transdermal versions of clonidine are used primarily to treat high blood pressure.

Brand-Name Forms

Aside from Kapvay, common brand-name forms of clonidine currently available include Catapres and Duraclon.

Off-Label Uses

Clonidine is sometimes prescribed off-label (i.e., for a use that was not initially FDA-approved) for various conditions, such as:

• Dysmenorrhea (painful cramps during the menstrual period)

• Hypertensive crisis (a sudden rise in blood pressure)

• Tourette's syndrome

• Management of hot flashes in menopause

• Prevention and treatment of migraines

• Alcohol and opiate (narcotic) withdrawal

• Smoking cessation therapy

• Diagnosis of pheochromocytoma (a tumor on a gland near the kidneys called the adrenal gland causing high blood pressure and a fast heart rate)
  

Clonidine for ADHD

Treatment for ADHD has traditionally included the use of psychostimulants, centrally acting alpha-2 adrenergic agonists, tricyclic antidepressants, and antipsychotics.

In some cases, however, the use of psychostimulant drugs or other types of drugs alone has not been effective in controlling symptoms of ADHD.

Thus, clonidine plays a vital role as a product that can work in combination with other medications to enhance their effectiveness and subsequently more effectively manage ADHD-related symptoms.

Medicines for ADHD can cause side effects, including insomnia, decreased appetite, weight loss, nausea, vomiting, and liver toxicity.

However, alpha-2 agonists, such as clonidine, are generally well tolerated and have been associated with fewer side effects.

Therefore, it is usually a choice of drug by healthcare professionals when treating ADHD.

Clonidine stimulates alpha-2 adrenergic receptors in the brain. It works to enhance attention and decrease impulsivity and hyperactivity symptoms in children with ADHD.

Dosing Guidelines

The following outlines basic dosing guidelines of clonidine for the treatment of high blood pressure versus ADHD.

Note, however, that your healthcare provider will ultimately determine your dosing regimen:

Side Effects and Safety

Like all drugs, clonidine, particularly for the treatment of ADHD, carries the potential for side effects of varying severity.

Therefore, monitor yourself or a loved one carefully for the emergence of side effects that worsen or fail to dissipate over time.

Common Side Effects

Common side effects of clonidine regarding its treatment of ADHD include the following:

• Constipation

• Dry mouth

• Decreased appetite

• Dizziness

• Irritability

• Lethargy

• Insomnia
  

Severe Side Effects

More severe, albeit rare, side effects of clonidine regarding its treatment of ADHD include the following:

• Hypotension (low blood pressure)

• Severe lethargy

• Withdrawal symptoms, including heightened blood pressure, headache, tachycardia (increased heart rate), lightheadedness, and chest tightness
  

Warnings and Precautions

Before starting treatment with clonidine, be aware of the following safety-related requirements that are linked to the effective use of clonidine:

• Do not use clonidine if you have any existing allergies to the drug's ingredients.

• Do not operate a machine or drive a vehicle after consuming clonidine.

Consult your healthcare provider before taking clonidine if you have the following pre-existing conditions:

• Kidney problems

• Low or high blood pressure

• Syncope (condition causing fainting)

• Heart disease

• Stroke

• Skin reaction (such as a rash) after applying a clonidine transdermal patch
  

Clonidine may negatively interact with select medications if taken together.

Therefore, tell your healthcare provider about all medications you have or currently take, with specific emphasis on the following:

• Antidepressants

• Medications for managing blood pressure

• Other medications that contain clonidine as an active ingredient

• Medications for combating insomnia
  

Finally, whether clonidine affects pregnant people is unknown. If you are pregnant or plan to become pregnant, talk to your healthcare provider.

People who breastfeed should know that clonidine is expelled through breast milk.

Therefore, ask your healthcare provider about alternative ways to feed your baby while taking clonidine.

Prevalence of ADHD

ADHD is one of the most common neurological disorders in children.

Based on 2016–2019 data from a national survey of parents, an estimated 6 million children 3–17 years old were diagnosed with ADHD in the United States.

Of note, ADHD is more prevalent in boys as compared to girls.

Based on data from the National Survey of Children’s Health (NSCH), the average onset for children with ADHD is 6 years old.

However, more severe cases of ADHD in children (as described by parents) have been diagnosed earlier, at around 4 years of age.

The symptoms of ADHD include hyperactivity, lack of attention, trouble staying focused, excessive talking, irresistible temptations, and difficulty following directions.

ADHD Treatment Options

Treatment options for ADHD include a combination of behavior therapy and medication. Cognitive behavior therapy (CBT) is recommended as the first line of treatment before prescription medication, particularly in preschool-aged children (4–5 years old).

CBT is a mental health treatment that focuses on the thoughts, beliefs, and attitudes affecting feelings and behavior.

Moreover, CBT helps children to cope with restlessness, control their emotions, and encourage them to think positively.

In addition to CBT and medication, a healthy lifestyle can help a child deal with ADHD symptoms. It includes healthy eating habits, physical activity, and adequate sleep each night based on age.

The FDA has approved two types of drugs to treat ADHD: stimulants and non-stimulants.

Stimulants contain various forms of methylphenidate and amphetamine, such as the commonly administered Adderall.

And conversely, there are non-stimulant drugs, a category that includes Strattera (atomoxetine), Kapvay (clonidine), and Qelbree (viloxazine).

Summary

Clonidine, a centrally acting alpha-agonist hypotensive agent, has historically treated high blood pressure.

However, in 2010, the FDA approved ER clonidine tablets, such as Kapvay, for the treatment of ADHD. Notably, for ADHD, Kapvay has proved to have greater efficacy and fewer side effects when compared to other ADHD medications.

Though availability may vary based on brand-name (as opposed to generic) options, clonidine is available for administration as an IR tablet, an ER tablet, a transdermal patch, and an IV injectable.

Always use the medicine for the indication prescribed by a healthcare provider. Ask your healthcare provider before switching between dosage forms.

One dosage form may not be effective for a different indication.

Wait for a few weeks before you feel an improvement in the symptoms. Never stop taking it on your own. Contact your healthcare provider if you have a side effect or question.

Frequently Asked Questions

How can I safely store clonidine?

Store clonidine in a secure, dry area at room temperature (68–77 degrees F). Do not place clonidine in any location susceptible to high moisture or heat levels.

Finally, if applicable, store clonidine away from children and pets.

How quickly will clonidine work to reduce symptoms of ADHD?

It may take four to eight weeks to feel the beneficial effects of clonidine in lessening ADHD symptoms.

Read the original article on Verywell Health.