clonidine ER

Adjunctive therapy

Brands: KAPVAY

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is clonidine ER?
Clonidine extended-release (brand Kapvay) is a non-stimulant ADHD medication and an alpha-2 adrenergic agonist. It is often used when stimulants are poorly tolerated, when sleep-onset problems are central, or as an adjunct to stimulants for residual hyperactivity/impulsivity.
What is KAPVAY?
KAPVAY is a brand name for clonidine ER.
What is KAPVAY (clonidine ER) used for?
Label indications include: Attention-deficit/hyperactivity disorder (ADHD) (extended-release formulation; product-dependent).
What drug class is KAPVAY (clonidine ER)?
Alpha-2 adrenergic agonist (non-stimulant ADHD medication).
What strengths does KAPVAY (clonidine ER) come in?
Extended-release oral tablets (often dosed twice daily).

Snapshot

Class: Adjunctive therapy
Common US brands: KAPVAY
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Attention-deficit/hyperactivity disorder (ADHD) (extended-release formulation; product-dependent).

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Clinical Highlights

Clonidine extended-release (brand Kapvay) is a non-stimulant ADHD medication and an alpha-2 adrenergic agonist. It is often used when stimulants are poorly tolerated, when sleep-onset problems are central, or as an adjunct to stimulants for residual hyperactivity/impulsivity. Compared with guanfacine ER, clonidine ER is often more sedating. That can be an advantage when insomnia is prominent, but daytime fatigue and dizziness can limit adherence if titration is too fast.

It tends to help hyperactivity/impulsivity and hyperarousal more than isolated inattentiveness. It is sometimes used as an add-on to stimulants when stimulants improve focus but sleep and evening rebound remain problematic.
In serious mental illness, clonidine ER can be attractive when stimulant activation or diversion risk is high, but hypotension, bradycardia, and additive sedation with other CNS depressants remain key monitoring targets.
The compare view, clonidine ER evidence feed, and clonidine ER print page can support shared decision-making and counseling on titration and tapering.

Dosing & Formulations

Typically dosed twice daily; bedtime dosing is common early to reduce daytime sedation. Typical initiation is at a low dose with weekly titration as tolerated. Typical total daily dosing is 0.1–0.4 mg/day (product- and age-dependent).

Improvement is often gradual over days to weeks. When sedation or dizziness emerges, slower titration and dose-timing adjustments are common strategies before concluding the medication is ineffective.
Abrupt discontinuation can trigger rebound hypertension, tachycardia, and agitation; tapering is generally used to reduce these effects.
If sedation limits daytime functioning, slower titration, shifting more of the dose to bedtime, and reviewing other sedating medications are common approaches.

Monitoring & Risks

Blood pressure and heart rate: typically checked at baseline and during titration; counseling often includes dizziness and orthostasis. Sedation: common early; co-use with other sedatives increases impairment risk and is generally minimized; driving/occupational safety is typically reviewed.

Rebound: abrupt discontinuation can cause rebound hypertension and irritability; plan tapering in advance.
Safety: falls/syncope risk is reassessed when dizziness is prominent; driving/occupational safety is reviewed during initiation and dose changes.

Drug Interactions

Additive hypotension or sedation can occur with other antihypertensives, CNS depressants, and alcohol. Other bradycardia-causing medications (e.g., some beta blockers) are often reviewed when symptomatic dizziness or syncope occurs.

Practice Notes

Clonidine ER is often used when sleep-onset problems and hyperarousal coexist with ADHD symptoms; sleep goals are commonly tracked in follow-up. When daytime fatigue dominates, slower titration or switching to guanfacine ER (often less sedating) is commonly considered rather than adding stimulants solely to counter sedation.

Because rebound symptoms can occur with abrupt discontinuation, taper plans are often documented early, including a discontinuation strategy for future care transitions.
When clonidine ER is used as add-on therapy, stimulant dose reduction is sometimes possible once sleep and hyperarousal improve (often reducing insomnia and appetite suppression).

References

Clonidine Hydrochloride Extended Release Tablets Prescribing Information — DailyMed (2025)
Attention deficit hyperactivity disorder (NICE guideline NG87) — NICE (2018)
Clinical Practice Guideline FOR THE Diagnosis, Evaluation, AND Treatment OF Attention Deficit/hyperactivity Disorder IN Children AND Adolescents — Pediatrics (2019)
Comparative Efficacy AND Tolerability OF Medications FOR Adhd (systematic Review AND Network Meta Analysis) — Lancet Psychiatry (2018)