Clonidine (Kapvay)

Mechanism of ActionClonidine is an alpha-2 adrenergic receptor agonist. It works by stimulating these receptors in the central nervous system, particularly in the brainstem. This stimulation reduces the release of norepinephrine, leading to a decrease in sympathetic nerve signals. As a result, clonidine calms hyperactivity and impulsivity and promotes focus by regulating the overactive noradrenergic system commonly seen in ADHD.
Clinical Benefits
  1. ADHD (Attention-Deficit/Hyperactivity Disorder):
    • Reduces hyperactivity, impulsivity, and distractibility.
    • Can help improve sleep disturbances, a common comorbidity in ADHD.
    • Effective as monotherapy or adjunct therapy to stimulants.
  2. Other Uses:
    • Treats symptoms of Tourette syndrome, including tics.
    • Off-label for anxiety disorders, opiate withdrawal, and sleep disturbances.


​Dosage
Clonidine is available in both immediate-release and extended-release formulations.
Kapvay (Extended-Release): Specifically approved for ADHD.
Starting Dose: 0.1 mg at bedtime.
Titration: Increase by 0.1 mg weekly, divided into morning and bedtime doses.
Maintenance Dose: Typically 0.2–0.4 mg/day in divided doses.
Maximum Dose: 0.4 mg/day.
Dosage adjustments are necessary for individuals with renal impairment or sensitivity to sedation.
  1. Common Side Effects (10-30%):
    • Fatigue or drowsiness
    • Dry mouth
    • Dizziness
    • Irritability
  2. Less Common Side Effects (1-10%):
    • Low blood pressure (hypotension)
    • Bradycardia (slow heart rate)
    • Constipation
  3. Rare but Serious Side Effects (<1%):
    • Syncope (fainting)
    • Rebound hypertension upon abrupt discontinuation
    • Depression or mood changes
Efficacy and Safety
  • Clonidine is particularly effective for ADHD patients who struggle with emotional dysregulation, sleep issues, or cannot tolerate stimulants.
  • The extended-release formulation (Kapvay) provides steady symptom control and minimizes peaks and troughs.
  • Its non-stimulant nature eliminates the risk of abuse, making it a safe choice for long-term use.

Sources:
  1. Prescribing Information for Kapvay (Clonidine Extended-Release), Concordia Pharmaceuticals.
  2. Connor DF, et al. "Clonidine for ADHD management: Clinical evidence and considerations." CNS Drugs.
  3. Wilens TE, et al. "The role of alpha-2 adrenergic agonists in ADHD treatment." Journal of the American Academy of Child & Adolescent Psychiatry.
  4. FDA Drug Database: Kapvay