Is Clonidine an Effective Treatment for ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that can affect how people behave. A doctor may prescribe medication to help manage the symptoms of ADHD. Clonidine is a medicine that people can take as a patch or tablet to help treat ADHD.

People with ADHD may have difficulty controlling their impulses, managing their energy levels, and maintaining their attention. A treatment plan for ADHD will usually involve therapy and medication. Standard ADHD medications include stimulant and non-stimulant medications.

People usually start taking stimulant medications and only switch to non-stimulants if they experience side effects. However, doctors may recommend that people with severe symptoms use non-stimulants in combination with stimulants.

Clonidine is a nonstimulant medication for ADHD that a doctor can also prescribe lower blood pressure. Currently, researchers still don’t know exactly how clonidine helps manage ADHD symptoms.

In this article, we discuss clonidine in more detail and look at the benefits and risks of taking this drug to treat ADHD.

Clonidine is a type of medicine known as an alpha-2 adrenergic agonist. The Food and Drug Administration (FDA) approved it to treat both arterial hypertension and ADHD, but doctors can also prescribe it for other off-label indications.

The drug received FDA approval for the treatment of ADHD in 2010. Clonidine may help lower blood pressure by relaxing the arteries, but researchers are still unsure of the exact mechanism by which it treats ADHD.

Doctors classify clonidine as a nonstimulant, making it a second-line drug for ADHD. Therefore, they may recommend the use of clonidine to help treat ADHD symptoms in people who do not respond well or cannot take stimulants. They may also suggest that people with severe ADHD symptoms take clonidine along with stimulants.

ADHD medications usually fall off in two categories: stimulant and non-stimulant drugs.

Stimulant drugs work on the central nervous system, increasing the levels of circulating neurotransmitters in the brain. Stimulant drugs are standard treatments for people with ADHD because they are effective. They act quickly and can reduce symptoms in about 70 to 80% children with the disease. This category of drugs includes:

In contrast, nonstimulant drugs may not affect the central nervous system. They usually take longer to start working, but their effect can last up to 24 hours. They can also help improve focus and attention while reducing impulsivity in someone with ADHD.

Doctors may recommend non-stimulant medications in the following situations:

  • when a person does not respond well to common stimulants
  • if stimulant drugs do not have the desired effect
  • if a person is unable to take stimulants

In some cases, doctors may recommend both a stimulant drug and a nonstimulant drug to increase the effectiveness of each.

Some non-stimulant drugs include:

Clonidine stimulates alpha-adrenergic receptors in the brain, which lowers the heart rate and relaxes blood vessels, lowering blood pressure. In people with ADHD, clonidine can affect the part of the brain that controls attention and impulsive behavior, but its exact mechanism is still unknown.

A 2016 review notes that alpha-2 adrenergic receptors in the part of the brain called the prefrontal cortex may help with inattentive, hyperactivity, and impulsive behaviors. Therefore, engaging these receptors with a drug such as clonidine can lead to a reduction in symptoms related to these behaviors.

the FDA approved long-acting clonidine to treat ADHD in people 6 years of age and older.

Doctors generally will not prescribe medications for children under this age group because experts know little about the effects of these medications in very young children. However, treatment options can help very young children with ADHD.

People with ADHD may receive treatment with clonidine by mouth or through a patch.

Oral clonidine is available as immediate launch and extended version tablets. Doctors usually recommend extended-release or long-acting versions of the drug, which break down slowly and deliver the drug to the body throughout the day. Depending on the dose, the person may take clonidine twice a day.

The other delivery option is a transdermal patch. A person can apply a sticky patch containing the medicine to the arm and it slowly delivers the medicine through the skin throughout the day. The patches can last much longer than the tablets, and a person may only need to change them weekly.

The dosage may vary slightly depending on the brand of the drug and the doctor’s recommendations. People should always follow their doctor’s advice.

Label information for Kapvay, which is a brand name extended-release form of clonidine, recommends starting with one 0.1 milligram (mg) tablet each day at bedtime.

After one week of this minimum dose, a person can increase the dose in 0.1 mg increments until they have the desired response to the drug. This approach helps a person find the lowest effective dose, which can prevent or minimize side effects of the drug.

After finding the minimum effective dose, a doctor may recommend dividing the daily dose into morning and bedtime doses. The bedtime dose should be equal to or greater than the morning dose to avoid fatigue during the day, as clonidine can cause drowsiness. So, if the person takes 0.3 mg each day, they would take 0.1 mg in the morning and 0.2 mg near bedtime.

Because clonidine is a nonstimulant medication, it may take longer for a person with ADHD to notice the effects than with a stimulant. It may take several weeks for a person to see the maximum benefit from clonidine, especially if it takes a week or more to determine the correct dosage to start.

However, once the treatment reaches its maximum effectiveness, a person should notice results each day that they take clonidine.

Clonidine is not a first-line treatment for ADHD, but doctors can prescribe it when stimulant medications aren’t working or there is a risk of an adverse reaction.

Using clonidine for ADHD can help treat symptoms of hyperactivity and impulsivity. A Article 2020 notes that non-stimulants, including clonidine, are both effective and well tolerated in children and adolescents as an adjunct to stimulant drugs. A 2016 review also notes that clonidine may have a synergistic effect with stimulant drugs, increasing their effectiveness.

Clonidine may also be a good option for some people who do not respond well to stimulant medications. It does not have the same effects on the body and will not cause the same side effects, so it may be easier for these people to tolerate.

Possible side effects of clonidine include:

Side effects may be more likely in people who are sensitive to the drug or taking a higher dose. Because clonidine can lower blood pressure, a person may need to monitor their blood pressure. People are also not advised to suddenly stop taking clonidine. People wishing to quit should discuss this with their doctor and slowly reduce the dosage to avoid complications of withdrawal.

Although clonidine was originally a medicine to control blood pressure, it can be a useful treatment for managing ADHD symptoms. Doctors classify it as a nonstimulant drug for ADHD. A doctor may recommend clonidine as a replacement for a stimulant medicine or advise a person to take it with a stimulant.

Researchers still aren’t sure exactly how clonidine helps treat ADHD, but it may work by acting on the part of the brain that influences inattention, hyperactivity, and impulsivity. People can work with their doctor to find the right medication and the right dosage to help treat their ADHD symptoms.

About Michael Bill

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