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Clonidine, sold under the brand name Catapres and Kapvay, among others, is an α2-adrenergic receptor agonist, hypotensive and anxiolytic agent used to treat hypertension, attention deficit hyperactivity disorder, perioperative pain, drug withdrawal (e.g., alcohol, opioids, or nicotine), and menopause. (2026). 9781108975292, Cambridge University Press. ISBN 9781108975292 (2026). 9781259584732, McGraw-Hill Education / Medical. ISBN 9781259584732 Clonidine is often prescribed off-label for Tic. It is used orally (by mouth), by injection, or as a transdermal skin patch. Onset of action is typically within an hour with the effects on blood pressure lasting for up to eight hours. Xylazine is a structural analog of clonidine.
Common side effects include dry mouth, dizziness, Headache, hypotension, and sleepiness. Severe side effects may include hallucinations, heart arrhythmias, and confusion. (2026). 9780857113382, Pharmaceutical Press. ISBN 9780857113382 If rapidly stopped, withdrawal effects may occur, such as a dangerous rise in blood pressure. Use during pregnancy or breastfeeding is not recommended. Clonidine lowers blood pressure by stimulating α2-adrenergic receptors and imidazoline receptors in the brain, which results in relaxation of many arteries.
Clonidine was patented in 1961 and came into medical use in 1966. It is available as a generic medication. In 2023, it was the 82nd most commonly prescribed medication in the United States, with more than 8million prescriptions.
Meta-analyses of randomized controlled trials in arterial hypertension have found that clonidine is an effective antihypertensive that leads to greater reductions in systolic and diastolic blood pressure than placebo. A 2024 network meta-analysis of imidazoline receptor agonists (i.e., moxonidine and clonidine) reported that this drug class produced ambulatory blood pressure reductions that were close in magnitude to those of commonly used first-line antihypertensive drug classes, but with higher odds of adverse effects such as dry mouth and sedation, especially with clonidine. Hypertension Canada's 2020 clinical practice guideline on resistant hypertension similarly notes that clonidine significantly lowers blood pressure in clinical trials, though it is considered a second-line therapy due to its potential for side effects. A 2025 review of randomized and observational studies on transdermal clonidine reported that once-weekly patch formulations achieve blood pressure reductions similar to Beta blocker, calcium channel blockers and Diuretic, while reducing the risk of Drug withdrawal-related rebound hypertension compared with oral clonidine.
Clonidine is not considered a first-line treatment for hypertension due to its propensity to cause sedation and xerostomia compared with other antihypertensive medications (e.g., angiotensin-converting enzyme inhibitors). (2026). 9783031667756 ISBN 9783031667756 When used for blood pressure control, clonidine is typically reserved for hypertensive emergencies rather than routine management hypertension, but it is considered appropriate for treating resistant hypertension.
Randomized controlled trials show that clonidine monotherapy reduces core ADHD symptoms, including inattention, hyperactivity, impulsivity and disruptive behavior, compared with placebo. Medical reviews on the efficacy of non-stimulant medications for ADHD indicate that clonidine produces moderate effect sizes for core symptom reduction, which are smaller than the large effect sizes reported for psychostimulants. In contrast to the rapid onset seen with psychostimulant medications, clinically significant symptom improvement may be delayed by a few weeks. Reviews of alpha-2 agonists suggest that this drug class may be more effective for managing hyperactivity and impulsivity than for inattentive ADHD symptoms, and that long-term treatment efficacy has been documented more extensively for guanfacine than for clonidine. Unlike psychostimulants, clonidine is regarded as having no abuse potential due in part to a lack of dopaminergic activity along the mesolimbic pathway. (2026). 9781260456905, McGraw Hill. ISBN 9781260456905
Clonidine is also used as an add-on to psychostimulant medications in individuals who have a partial response to psychostimulants, cannot tolerate higher psychostimulant doses, or experience notable early-morning or evening symptoms. In a randomized controlled trial of ADHD children with an incomplete response to psychostimulants, the addition of clonidine extended-release produced greater reductions in ADHD symptom scores than continuing psychostimulant monotherapy. α2 adrenoreceptor agonists may also improve symptoms in comorbidities of ADHD such as Tic disorder, oppositional or aggressive behavior, and insomnia. (2024). 9781009464772, Cambridge University Press. ISBN 9781009464772
Sleep disturbances are common in individuals with ADHD and may arise both from the disorder itself and as adverse effects of psychostimulant medications, which can cause delayed sleep onset and insomnia. Whilst clonidine's sedative properties, particularly in its immediate-release formulation, can limit its acceptability as a monotherapy for core ADHD symptoms during the daytime, it has been used as a sleep aid in ADHD individuals who are also treated with psychostimulants and experience insomnia. Evidence suggests that immediate-release clonidine taken at bedtime can reduce sleep-onset difficulties and night-time awakenings, but its treatment effects do not persist into the following day and it is therefore not generally effective for daytime ADHD symptoms when used in this manner.
A 2017 systematic review and meta-analysis of 57 randomized controlled trials (RCTs) found that clonidine improved postoperative pain control. In a subset of trials reporting detailed postoperative analgesia outcomes, clonidine delayed the time until patients required additional pain medication and reduced cumulative postoperative analgesic consumption over the first 24 hours by ~24%. The same review reported that clonidine reduced the incidence of postoperative nausea and vomiting compared with placebo. Meta-analyses of α2 adrenoreceptor agonists (i.e., clonidine and dexmedetomidine) likewise report small to moderate reductions in postoperative pain intensity and opioid consumption during the first postoperative day, consistent with an opioid-sparing effect, but are limited by substantial statistical heterogeneity. In one meta-analysis of clonidine RCTs, overall adverse event rates did not differ significantly between clonidine and placebo. However, that same paper noted that a large included trial reported a higher incidence of hypotension and non-fatal cardiac arrest with clonidine, and that the available data were insufficient to rule out uncommon but serious hemodynamic complications.
Clonidine has also been suggested as a treatment for rare instances of dexmedetomidine withdrawal.
Gastrointestinal side effects can include xerostomia, constipation, nausea, and vomiting. Colonic pseudo-obstruction has been described as a rare side effect.
Other reported physical side effects include headache, fatigue or weakness and, less commonly, urinary retention and transient edema. In addition to dry mouth, clonidine has been reported to reduce Tears (i.e., dry eyes), a rare side effect that may be more noticeable in people who wear Contact lens.
Skin reactions appear to occur uniquely with transdermal formulations of clonidine; contact dermatitis at the transdermal patch application site has been reported in about 15% to 20% of users.
α2 adrenoceptors are Gi/Go-coupled G protein-coupled receptors that signal through heterotrimeric G proteins made up of a Gαi/o subunit protein and a paired Gβγ subunit complex (i.e., the β and γ subunits). After receptor activation, Gαi/o and Gβγ can separate, and both components contribute to inhibition of neuronal activity and neurotransmitter release. Gαi/o inhibits adenylyl cyclase, which decreases the expression of cyclic adenosine monophosphate (cAMP) and ceases protein kinase A (PKA)-dependent phosphorylation of amino acid residues involved in neuronal excitability and synaptic signaling. In parallel, Gβγ can increase K+ conductance through G protein-coupled inwardly rectifying potassium channels (GIRKs), an effect that reduces neuronal firing through membrane hyperpolarization.
In noradrenergic presynaptic neurons in the sympathetic nervous system, α2 adrenoceptors act as inhibitory Autoreceptor that inhibit action potential-evoked neurotransmitter release. After presynaptic α2 adrenoceptor activation by clonidine, the released Gβγ dimer can inhibit voltage-gated Ca2+ channels (including P/Q-type and N-type channels), which reduces Ca2+ entry during presynaptic depolarization and lowers vesicular neurotransmitter release. Gβγ signaling can also increase K+ conductance (including via GIRKs) to oppose presynaptic depolarization and further limit voltage-gated Ca2+ channel activation. In addition, Gβγ can bind proteins within the SNARE complex (e.g., SNAP-25), which can suppress synaptic vesicle fusion downstream of Ca2+ entry. These mechanisms reduce the release of norepinephrine and other neurotransmitters from affected nerve terminals.
Clonidine lowers arterial blood pressure primarily by reducing sympathetic nervous system activity and increasing vagus nerve activity to the heart. In the medulla oblongata, activation of α2 adrenoceptors reduces the firing of neurons that are responsible for sympathetic nerve signaling to the heart, , and peripheral vasculature and can slow heart rate by increasing vagal tone. At postganglionic nerve fibers, presynaptic α2 adrenoceptors function as inhibitory autoreceptors that suppress nerve-evoked release of norepinephrine and other signaling compounds (including adenosine triphosphate and neuropeptide Y). These central and peripheral actions are associated with decreased plasma norepinephrine and reduced urinary catecholamine excretion, and with reductions in plasma renin and urinary aldosterone reported alongside decreases in total peripheral resistance and heart rate. With intravenous administration, clonidine may cause a short-lived increase in blood pressure attributed to α2 adrenoceptor-mediated vasoconstriction in vascular smooth muscle, followed by a more sustained hypotensive response once clonidine crosses the blood brain barrier and binds to its receptor sites in the medulla oblongata; this biphasic pattern is generally less evident with oral or transdermal routes of administration due to dilution of the drug before reaching circulation.
In the prefrontal cortex, α2A is the predominant α2 adrenoceptor subtype, and clonidine's attention- and working memory-related effects are attributed to postsynaptic α2A activation. Across the brain more generally, α2A and α2C adrenoceptors are widely distributed, while α2B is primarily expressed in the thalamus. α2A adrenoceptors on of prefrontal pyramidal neurons can close hyperpolarization-activated cyclic nucleotide-gated channels (HCNs) to promote attentional control and working memory. The mechanism behind this behavioral effect has been described as the consequence of improved signal-to-noise ratio in the prefrontal cortex, which can facilitate focused attention on relevant stimuli and improved cognitive control of behavior.
Sedation is attributed to clonidine's activity on noradrenergic neurons of the locus coeruleus and thalamus. Somatodendritic α2 adrenoceptors reduce locus coeruleus firing, and presynaptic α2 adrenoceptors reduce norepinephrine release along noradrenergic pathways, in turn lowering noradrenergic modulation of arousal in the ascending reticular activating system. α2 adrenoceptors are also expressed on that release several other neurotransmitters (i.e., serotonin, dopamine, acetylcholine, GABA, and glutamate), and their activation can suppress release at these synapses as well.
Clonidine produces analgesic effects in part through α2 adrenoceptors in the dorsal horn of the spinal cord. In primary nociceptive neurons, α2A and α2C adrenoceptors are present on axon terminals and can be co-localized with Neuropeptide involved in nociceptive signaling (e.g., substance P and calcitonin gene-related peptide), and clonidine inhibits their release in preclinical models. Activation of α2 adrenoceptors in the spinal cord reduces excitatory input to dorsal horn neurons and decreases dorsal horn neuron firing, thereby inhibiting nociceptive signaling.
The discovery of imidazoline receptors has prompted investigation of I1 receptor contributions to Clonidine's cardiovascular effects. I1 receptors are widely distributed, including in the central nervous system, and I1 activation has been implicated in clonidine's sympatholytic effect. One proposed model is that I1 receptor activation in the brainstem facilitates endogenous catecholamine signaling that then activates α2 adrenoceptors to reduce sympathetic activity and blood pressure, but the magnitude of I1 receptors in clonidine's hypotensive effects remains unsettled.
Measurements of the half-life of clonidine vary widely, between 6 and 23 hours, with the half-life being greatly affected by and prolonged in the setting of kidney disease. Variations in half-life may be partially attributable to CYP2D6 genetics. Some research has suggested the half-life of clonidine is dose dependent and approximately doubles upon chronic dosing, while other work contradicts this. Following a 0.3 mg oral dose, a small study of five patients by Dollery et al. (1976) found half-lives ranging between 6.3 and 23.4 hours (mean 12.7). A similar N=5 study by Davies et al. (1977) found a narrower range of half-lives, between 6.7 and 13 hours (mean 8.6), while an N=8 study by Keraäen et al. that included younger patients found a somewhat shorter mean half-life of 7.5 hours.
History
Clonidine was introduced in 1966. It was first used as a hypertension treatment under the trade name of Catapres.
Society and culture
Brand names
As of June 2017, clonidine is marketed under many brand names worldwide: Arkamin, Aruclonin, Atensina, Catapin, Catapres, Catapresan, Catapressan, Chianda, Chlofazoline, Chlophazolin, Clonid-Ophtal, Clonidin, Clonidina, Clonidinã, Clonidine, Clonidine hydrochloride, Clonidinhydrochlorid, Clonidini, Clonidinum, Clonigen, Clonistada, Clonnirit, Clophelinum, Dixarit, Duraclon, Edolglau, Haemiton, Hypodine, Hypolax, Iporel, Isoglaucon, Jenloga, Kapvay, Klofelino, Kochaniin, Lonid, Melzin, Menograine, Normopresan, Paracefan, Pinsanidine, Run Rui, and Winpress. It is marketed as a combination drug with chlortalidone as Arkamin-H, Bemplas, Catapres-DIU, and Clorpres, and in combination with bendroflumethiazide as Pertenso.
Research
Borderline personality disorder
A systematic review of psychopharmacology in borderline personality disorder identified clonidine as a promising adjunctive therapy targeting noradrenergic dysregulation, especially in comorbid PTSD cases. However, it emphasized the limitations of small sample sizes and called for larger placebo-controlled trials.
Notes
External links
Categories: Alpha2-adrenergic Agonists, Anilines, Antihypertensive Agents, Antimigraine Drugs, Anxiolytics, Appetite Stimulants, Attention Deficit Hyperactivity Disorder Management, Chlorobenzene Derivatives, Drugs Developed By Boehringer Ingelheim, Drugs Developed By Novartis, Guanidines, Imidazoline Receptor Modulators, Imidazolines, Ophthalmology Drugs, Wikipedia Medicine Articles Ready To Translate, Products Introduced In 1961
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