Nonstimulants

Clonidine for ADHD

Clonidine is the generic name for an alpha-adrenergic agonist medication typically taken to treat hypertension, or high blood pressure. In 2009, its extended-release formulation was approved by the FDA to treat ADHD in children. Clonidine is thought to increase norepinephrine in the brain, which can help ADHD symptoms.

Clonidine for ADHD

Medically Reviewed by William Dodson, M.D., a member of ADDitude’s ADHD Medical Review Panel

What Is Clonidine?

Clonidine is the generic name for a medication taken to reduce blood pressure, or hypertension. It is part of the alpha-adrenergic agonist class of medication. Clonidine for high blood pressure affects nerve impulses in the brain to relax the blood vessels, allowing blood to pass through more easily, and lowering blood pressure.

In 2009, the FDA approved the use of extended-release clonidine for treating ADHD in children1. It’s unknown how it works to improve ADHD symptoms like impulsivity and restlessness2.

Clonidine for ADHD

Kapvay is the brand name for an extended-release formulation of clonidine, also called clonidine ER. It was approved by the U.S. Food and Drug Administration (FDA) in 2009 for ADHD in children and adolescents ages 6 to 17 as monotherapy, or in addition to stimulant ADHD medications1.

Catapres is the brand name for a immediate-release formulation of clonidine. Immediate-release clonidine is not FDA-approved to treat ADHD. It is sometimes used off-label because there is some evidence that the immediate-release formulation also relieves ADHD symptoms3. Catapres can be very expensive, especially when used off-label, and generic clonidine tends to work just as well.

The extended-release formulation slows down the absorption of the medication to limit side effects. Most adolescent and adult patients tolerate immediate-release clonidine well, especially if it is taken before bed. Small children may benefit from the extended-release formulation.

Clonidine: A Non-Stimulant Medication for ADHD

Stimulant medications are the first-line treatment for ADHD4 because they are considered the most effective; they alleviate symptoms for 70-80% of people with attention deficit hyperactivity disorder (ADHD or ADD). There are two types of stimulants: methylphenidates like Concerta, Ritalin and Daytrana, and amphetamines like Adderall, Dexedrine, and Evekeo.

Non-stimulant ADHD medications are the second-line treatment for people who:

  • Don’t experience complete symptom relief with stimulants
  • Experience severe side effects form stimulants
  • Can’t take stimulants because of a health condition, like heart disease

There are several types of non-stimulant medications for ADHD: antidepressants, alpha-adrenergic agonists like clonidine, wakefulness promoting medications, and anti-viral medications.

Alpha-adrenergic agonists, like clonidine, work best when used in addition to stimulant medications. Stimulants help improve focus, and decrease distractibility, while alpha agonists treat symptoms like impulsivity, emotional regulation, and insomnia.

The non-stimulant medications that are FDA-approved to treat ADHD include Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine).

Guanfacine and clonidine appear to work equally well for different patient populations. Individuals respond differently to different medications. If you don’t experience benefits from taking one medication, work with your physician to stop taking it, and try the other option. Most patients experience benefit from one or the other.

Benefits of Clonidine for ADHD

Clonidine extended-release tablets significantly decrease ADHD symptoms including hyperactivity, impulsivity, and inattention for children ages 6 to 175.

Clonidine can expand or extend the benefits of stimulant ADHD medications for children whose symptoms aren’t fully alleviated by stimulant medication6, especially for children with oppositional defiant disorder, Tourette’s syndrome, or tics2.

Clonidine can reduce conduct, or aggressive behavior, problems for children with ADHD when used in addition to stimulant medication7.

Clonidine can alleviate insomnia when used in addition to stimulant ADHD medications8.

Clonidine reduces symptoms, with fewer side effects, than other ADHD medications for some patients9.

Clonidine has a low risk of abuse or dependence. It is not a controlled substance, and may be a good option for someone with ADHD and a history of substance abuse.

Disadvantages of Clonidine for ADHD

Clonidine can be very sedating, which can make it hard to function at work or drive a vehicle10.

Clonidine does not last as long as some other non-stimulants, like guanfacine10.

Non-stimulant medications are only FDA-approved for certain age groups. Intuniv and Kapvay are approved for children and adolescents, but not for adults. Catapres and generic forms of immediate-release clonidine and guanfacine are approved for adults, but not children. This can impact insurance coverage.

Forms and Dosage of Clonidine

Clonidine is available as an immediate-release tablet or transdermal patch (Catapres) and an extended-release tablet (Kapvay). Catapres is available in 0.1, 0.2, and 0.3 mg tablets. Kapvay is available in 0.1 and 0.2 mg tablets.

The optimal dosage varies patient by patient. Your doctor will likely start you or your child on the lowest dose available, and then increase the dosage over 2 to 7 days until you determine the right dose.

Side Effects of Clonidine for ADHD

The most common side effects of clonidine are:

  • Orthostatis, a feeling of dizziness or lightheadeness upon standing
  • Dry mouth
  • Tiredness
  • Weakness
  • Headache
  • Nervousness
  • Nausea
  • Vomiting
  • Constipation
  • Sexual side effects

Other serious side effects include low blood pressure, irregular heart rate, or changes to mental health including hallucinations. If you experience rash, hives, swelling, difficulty swallowing or breathing, or hoarseness, it could be a sign of a more serious reaction. You should call your doctor or seek medical treatment immediately.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.


Sources

1 FDA. “Pediatric Postmarketing Pharmacovigilance and Drug Utilization Review.” Department of Health and Human Services Public Health Service Food and Drug Administration Center for Drug Evaluation and Research Office of Surveillance and Epidemiology, 20 Nov. 2017. Web. 23 Jun. 2019.
2 Sallee, Floyd R. “The Role of Alpha 2 Agonists in the Attention Deficit/Hyperactivity Disorder Treatment Paradigm.” Medscape, 2008. Web. 23 Jun. 2019.
3 Ming, Xue, et al. “Safety and efficacy of clonidine and clonidine extended-release in the treatment of children and adolescents with attention deficit and hyperactivity disorders.” Adolescent Health, Medicine and Therapeutics, 2: 105-112. 30 September 2011. doi: 10.2147/AHMT.S15672
4 Pliszka, Steven, et al. “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.” Journal of the American Academy of Child & Adolescent Psychiatry, 46(7): 894-921. July 2007. doi: 10.1097/chi.0b013e318054e724
5 Jain, Rakesh, et al. “Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder.” Journal of the American Academy of Child & Adolescent Psychiatry, 50(2): 171-9. February 2011. doi: 10.1016/j.jaac.2010.11.005
6 Kollins, Scott, et al. “Clonidine Extended-Release Tablets as Add-on Therapy to Psychostimulants in Children and Adolescents With ADHD.” Pediatrics, 127(6): 1406-1413. June 2011. doi: 10.1542/peds.2010-1260
7 Hazell, Philip, L., et al. “A Randomized Controlled Trial of Clonidine Added to Psychostimulant Medication for Hyperactive and Aggressive Children.” Journal of the American Academy of Child & Adolescent Psychiatry, 42(8): 886-894. June 2011. doi: 10.1097/01.CHI.0000046908.27264.00
8 Barrett, Jessica, et al. “To sleep or not to sleep: a systematic review of the literature of pharmacological treatments of insomnia in children and adolescents with attention-deficit/hyperactivity disorder.” Journal of the American Academy of Child & Adolescent Psychopharmacology, 23(10): 640-7. December 2013. doi: 10.1089/cap.2013.0059
9 Ruiling, Luan, et al. “Efficacy and Tolerability of Different Interventions in Children and Adolescents with Attention Deficit Hyperactivity Disorder.” Frontiers in Psychiatry. 13 November 2017. doi: 10.3389/fpsyt.2017.00229
10 Kolar, Dusan, et al. “Treatment of adults with attention-deficit/hyperactivity disorder.” Neuropsychiatric Disease and Treatment, 4(2): 389-403. 11 April 208. doi: 10.2147/NDT.S6985
11MedlinePlus. “Clonidine.” The American Society of Health-System Pharmacists, Inc. U.S. National Library of Medicine. Updated May 15, 2017. https://medlineplus.gov/druginfo/meds/a682243.html

Updated on July 15, 2019

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