clonidine

Adjunctive therapy

Brands: CATAPRES

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is clonidine?
Clonidine (brand Catapres) is a centrally acting alpha-2 adrenergic agonist approved for hypertension (label). In psychiatric practice it is sometimes used off-label as an adjunct for hyperarousal, anxiety-related insomnia, and withdrawal-related symptoms when reducing sympathetic activation is part of the treatment goal.
What is CATAPRES?
CATAPRES is a brand name for clonidine.
What is CATAPRES (clonidine) used for?
Label indications include: Hypertension (label). Psychiatric uses are typically off-label (formulation- and population-dependent).
What drug class is CATAPRES (clonidine)?
Alpha-2 adrenergic agonist; reduces central sympathetic outflow (antihypertensive; also used off-label in psychiatry).
What strengths does CATAPRES (clonidine) come in?
Immediate-release tablets: 0.1 mg, 0.2 mg, 0.3 mg.

Snapshot

Primary label indications include: Hypertension (label).
Class: Adjunctive therapy
Common US brands: CATAPRES
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Hypertension (label). Psychiatric uses are typically off-label (formulation- and population-dependent).

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Clinical Highlights

Clonidine (brand Catapres) is a centrally acting alpha-2 adrenergic agonist approved for hypertension (label). In psychiatric practice it is sometimes used off-label as an adjunct for hyperarousal, anxiety-related insomnia, and withdrawal-related symptoms when reducing sympathetic activation is part of the treatment goal. Clonidine is not a first-line stand-alone medication for chronic anxiety disorders, but it may help some physical symptoms (racing heart, agitation, insomnia) when paired with primary treatments (therapy and/or first-line antidepressants) (clinical practice pattern).

The main safety limits are hypotension, bradycardia, dizziness, and sedation. Because it lowers blood pressure and heart rate, monitoring is typically more important than with many “as-needed” anxiety adjuncts (label).
Abrupt discontinuation can cause rebound hypertension and agitation; tapering is commonly used to reduce risk, especially at higher doses or with long-term use (label).
The compare view, clonidine evidence feed, and clonidine print page can help weigh alternatives and support counseling about monitoring and taper planning.
Best fit is usually an adjunct role in patients who can tolerate blood pressure lowering and where sedation at night (or reduced sympathetic arousal) is a desired effect rather than a problem.

Dosing & Formulations

Tablets: 0.1 mg, 0.2 mg, 0.3 mg (label). Hypertension labeling commonly starts at 0.1 mg twice daily (morning and bedtime) with weekly increases of 0.1 mg/day as needed (label).

Taking a larger portion of the daily dose at bedtime can reduce transient dry mouth and drowsiness during initiation (label).
For off-label psychiatric use (sleep or hyperarousal), clinicians often start lower and individualize dosing to vitals and daytime functioning rather than titrating aggressively (clinical practice pattern).
If discontinuing after regular use, gradual tapering is commonly used to reduce rebound hypertension and agitation (label).

Monitoring & Risks

Blood pressure and heart rate: typically checked at baseline and during titration; counsel about dizziness and orthostasis (label). Sedation and impaired alertness can occur, especially early and with other sedatives; assess driving/occupational safety during dose changes.

Rebound risk: missing doses or abrupt discontinuation can trigger marked blood pressure elevation and agitation; taper planning is a key safety step (label).
Renal impairment can prolong half-life (up to ~41 hours reported in severe impairment), increasing sedation/hypotension risk (label).

Drug Interactions

Additive hypotension or bradycardia can occur with other antihypertensives and some rate-controlling agents; symptomatic dizziness or syncope prompts review of the full regimen (label/class). Additive sedation can occur with alcohol and other CNS depressants, including sedating antipsychotics and hypnotics.

When combined with beta blockers, discontinuation planning is important because rebound hypertension risk can increase if clonidine is stopped abruptly (label/class).

Practice Notes

In ADHD, alpha-2 agonists (including clonidine ER) are guideline-backed non-stimulant options; immediate-release clonidine is sometimes used off-label but is not interchangeable with ER products (guidelines / label). When insomnia is the main target, compare clonidine with alternatives that do not lower blood pressure (e.g., hydroxyzine, trazodone, DORAs) and choose based on comorbidity and safety profile.

If anxiety persists, the primary treatment is usually psychotherapy and an SSRI/SNRI; clonidine is typically an adjunct for symptoms rather than a core long-term strategy.
Document a taper plan early, especially when care transitions are likely, to reduce the chance of abrupt discontinuation and rebound hypertension.

References

Clonidine hydrochloride 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)