This is my fifth installment for my ADHD Medication and Behavior series! This time we are focusing on Clonidine, another alpha-2-adrenergic agonist medication used as a second line agent for ADHD treatment. This is similar to guanfacine, which I blogged about a few days ago and available here. The difference between these two medications are that Clonidine binds non-selectively to these types of receptors that are found not just in the brain but also in other organ systems, and thus can lead to greater side effects, whereas Guanfacine will more selectively bind (or be attracted to/stick) to the receptors only in the brain.
This class of medications are non-stimulant options for the treatment of ADHD. If you look at the website for these drugs, you will see that there are no FDA approvals for the use of these drugs in children below 6 years of age. However, I tend to use these drugs in younger children who have problems sleeping, are impulsive and aggressive because of their emotional dysregulation. I tend to select Clonidine when sleep is so fragmented and is the overriding concern of those three symptoms/behaviors and we just need to get everyone a good night’s sleep.
I always start this medication at the lowest dose. The reason is because while on paper the medicine is said to last a certain length of time, I always do a “test” to see how the child will react. So I prepare families that they may not see the “sleepiness” factor right away especially on the lower doses. BUT, I do want to make sure we know how the child will react to the medicine first.
Things to look for:
- Note how long it takes the child to fall asleep (if the right dose, should be within 30-60 minutes of giving the medicine). Therefore talk with your child’s doctor about your ideal bedtime when thinking about what time it should be given.
- Note how your child is upon awakening. I don’t want children to be groggy or still sleepy.
- Remember, these medications work in the following order on the symptoms of concern–improve sleep first, then impulse and aggression control within 2-3 weeks of giving the medicine daily.
This medicine can be prescribed in conjunction with a stimulant.
Your child’s doctor will want to get a thorough cardiac history to ensure there are no health risks with giving this medication to your child. They will also want to document a baseline blood pressure. These medications can affect blood pressure but at the doses given to children for ADHD treatment, we don’t expect too much change–but something to note.
If your child experiences side effects with the medication, talk to your child’s doctor and do NOT STOP it cold turkey. It will be important to wean the medicine off (titrate) so your child will not experience any withdrawal effects.
There are immediate acting and extended release preparations for Clonidine and Guanfacine. Your child’s doctor will talk with you about the options. Sometimes it will depend upon insurance which type is approved to use first.
Considering using a Medication Log when starting a new medicine or adjusting the dose. It will help you and your doctor pinpoint whether a medicine is doing what it should be doing. As always, please feel free to give suggestions on improving this handout or requests for additional topics by posting or submitting requests through my blog!
ALSO, advice given on my blog about medications is NOT A SUBSTITUTE FOR MEDICAL ADVICE by your child’s physician. Always talk to your child’s doctor directly about their thoughts on the appropriate medicine and other treatments for your child’s ADHD. Medicine is just one type of treatments available.
RELATED: Non-stimulant Medications Available for ADHD Treatment (HealthyChildren.org)