Clonidine: Is It a Medication Choice for ADHD?

Clonidine is a medication that was originally prescribed to help people with high blood pressure. However, because of the calming effect it has on the body, clonidine has been found to help people with ADHD symptoms like hyperactivity, impulsivity, aggression, over-arousal, and sleep difficulties.

In 2010, the U.S. Food and Drug Administration (FDA) approved clonidine as a medication for children with ADHD to be taken either alone or with a stimulant medication.

Trade names for clonidine include Catapres® and Kapvay®.

Overview

ADHD medications are generally categorized as stimulant and non-stimulant. Clonidine is considered a non-stimulant treatment for ADHD

Stimulants (also called psychostimulants) are generally the first line of medications used for ADHD. First line means they are usually the first choice for treatment. They are the most prescribed ADHD medications because they are known to be the most effective way to reduce ADHD symptoms like impulsivity, hyperactivity, and inattentiveness. There are two types of stimulants: amphetamines and methylphenidates. Examples are Adderall® and Ritalin®.

Non-stimulant medications are usually prescribed if a person doesn't tolerate stimulant medication because of severe side effects. Non-stimulant medication may also be chosen if a person has a health reason why stimulants cannot be prescribed, such as certain psychiatric disorders, sleep disorders, cardiovascular disease, or a history of stimulant abuse.

Strattera® (atomoxetine) the anti-depressant medication Wellbutrin® XL (bupropion hydrochloride) and the antihypertensive drug Intuniv® (Guanfacine) are examples of other non-stimulant medications.

Stimulants vs. Non-Stimulants 

Stimulant ADHD medications work by causing more dopamine and norepinephrine to be available in the synapses of the brain.

 This increase stimulates the central nervous system and improves cognitive functioning, such as attaining information and understanding ideas. Because the nervous system is stimulated, some people report feeling jittery, anxious, and on edge when they take a stimulant medication.

Clonidine works differently. Instead, it causes the brain to send signals to the blood vessels lowering blood pressure. In addition, Clonidine releases norepinephrine into the prefrontal cortex area of the brain. This is the place where the brain’s executive functions occur, such as planning, organizing, and using information and experiences. This allows a person to be calm physically, yet be mentally focused.

Benefits 

Enhances the Effect of a Stimulant

Clonidine can be prescribed in addition to a stimulant medication. This can often enhance the effectiveness of the stimulant.

Appetite Neutral

Clonidine is appetite neutral, which means it does not increase or decrease appetite. Appetite can often be suppressed when a person takes a stimulant medication, which can be a problem for underweight people.

Reduces Anxiety 

People who have ADHD often experience anxiety as well. A medication from the benzodiazepine family, such as Xanax® or Valium®, is often prescribed for anxiety.

However, these are considered habit forming and can negatively affect cognitive functions like attention. For this reason, clonidine is often prescribed to help people with ADHD who have anxiety.

Aids Sleep Problems

Sleep problems are another issue many people with ADHD face. A potentially positive effect of taking clonidine is it can help improve sleep. In fact, some doctors prescribe a low dose of clonidine ‘off label’ (this means using an FDA-approved drug for an unapproved use) to help with sleep.

While traditional benzodiazepine sleeping medications might be avoided because they can be habit forming, clonidine is not considered to be habit forming.

High Blood Pressure Reduced

If a person has ADHD and high blood pressure then clonidine may be a good choice. It will help to reduce blood pressure and help treat ADHD symptoms.

Tourette Syndrome and Tic Disorder Helped 

If a person has Tourette syndrome and ADHD, clonidine can help the symptoms of both. A combination of clonidine and a stimulant medication can be helpful for a tic disorder.

Drawbacks 

Does Not Help All ADHD Presentations

Clonidine helps hyperactivity, impulsivity, aggression, over-arousal, and sleep difficulties. However, it has not been found to be as helpful for inattentive symptoms of ADHD.

Little Research For Adult ADHD

Studies have shown clonidine can help ADHD symptoms in children and adolescents. Yet there is little research to show the effectiveness of clonidine in adult ADHD. This could be because the symptoms that clonidine helps the most, such as aggression, hyperactivity and impulsivity, often diminish in adulthood.

Less Effective Than Stimulants

Clonidine is not as effective as stimulant medications for treating ADHD symptoms. However, clonidine’s effects are significant enough for the FDA to approve its use for ADHD.

Brain Fog

Rather than increasing the ability to focus, some people find clonidine reduces their focus or causes ‘brain fog.’ The problems with ability to focus can be temporary, as the body adjusts to the clonidine. However, some people find this problem continues.

Feeling Sleepy 

While sleeping better at night can be a positive benefit of taking clonidine, some people feel fatigued or sedated during the daytime too. This can have negative effects on school or work performance. Sometimes, the sleepiness reduces with time. This is an important side effect that a doctor should be made aware of, as it has the potential to be dangerous if a person drives a vehicle or operates machinery.

Erectile Dysfunction

A drawback for men taking clonidine is erectile dysfunction (ED). Even though a man might feel a little embarrassed to talk to a doctor, the doctor will be aware that this is a common side effect and will want to help resolve this issue.

Forms and Dosage

When clonidine is first prescribed, it is usually at the lowest dose. This may be 0.05 to 0.1milligram to start. Working with a doctor, the dose is gradually increased until the effective (therapeutic) dose is found. Tablets (Catapres®) come in 0.1, 0.2, and 0.3 milligrams. Extended release (Kapvay®) is available in 0.1 and 0.2 milligrams.

Clonidine is also available in patches. Patches last seven days. They are a good option for a person who tends to forget to take medication or does not like swallowing tablets. Once the therapeutic dose has been found using tablets, having a clonidine patch is an option.

How Long to Feel Effects 

It may take a few weeks to see the full effects of clonidine on ADHD symptoms, but some improvement may occur sooner.

Side Effects

The common side effects of clonidine include fatigue, headache, dizziness, dry mouth, irritability, upper abdominal pain, behavior problems, and low blood pressure. These can often reduce after some time of taking the medication.

More serious  but rarer side effects include irregular heartbeat, slow heart rate, hallucinations. A person who experiences these or any other persistent side effects should contact a doctor as soon as possible.

A person who has a history of low blood pressure prior to taking clonidine may be more likely to feel dizziness, lightheadedness and nauseous when taking clonidine. Many people forget to take their medication—if you do, a double dose should not be taken, as that could unsafely lower blood pressure.

It is important that clonidine not be stopped abruptly, as this may cause rebound high blood pressure. Instead, the dose should be decreased gradually. A doctor can provide advice on the best tapering schedule.

Clonidine is a Category C medication. This means it is a drug that may be unsafe to an unborn baby. It is important for a woman to tell her doctor if she is pregnant, breastfeeding, or planning to become pregnant.

In Summary

In summary, while clonidine is not usually the first choice of medication for ADHD, it can be helpful in treating ADHD symptoms, either alone or combined with another ADHD medication. If you are interested in it as a treatment option, bring it up with your doctor. They'll help decide if it's right for you.