Nonstimulants for ADHD: Clonidine (Kapvay)

Clonidine is a nonstimulant commonly used to treat ADHD.  It is probably not as effective as the stimulants.  It is commonly used as a sleep aid in patients with ADHD.  It may also be helpful for ODD, residual impulsiveness/aggression, and Tourette's syndrome.

Clonidine is typically given as a pill in the immediate release form, but is also available in an extended release tablet.  The immediate release form may be crushed if the patient cannot swallow pills.   Clonidine extended release tablets do not last longer in the patients system, but they do show a lower peak concentration of the drug in the blood early on, which could be helpful in avoiding side effects.  Clonidine is also available as a patch and liquid, and in an extended release form in an  oral suspension, but these forms are not usually used for ADHD.

Side effects

Clonidine is a blood pressure medication and has been around for a long time, even though it has only recently been approved by the FDA for use in treating ADHD.  Its side effects are well known and include low blood pressure (patients must take care to stay well hydrated), low heart rate, sleepiness (often temporary, but not so great if you have to drive), discontinuation syndrome (rebound high blood pressure, must be tapered from higher doses), abdominal pain, and headaches.   Rarely, patients may suffer from emotional symptoms or nightmares.   Because clonidine often must be tapered, side effects can last for a week or more after the decision is made to stop the medicine.

Clonidine is usually safe for patients with seizure disorders and may suppress tics.

While it has low addictive potential, clonidine is also used to curb symptoms of drug and alcohol withdrawal.  As such, it has street value, so parents must make sure that their children swallow their medication.  This is usually not difficult as clonidine is typically given at night, to minimize daytime drowsiness.

Pregnancy and nursing

Clonidine is considered pregnancy class C, meaning effects on an unborn child are unknown.  For many years clonidine was used for treatment of pregnancy induced hypertension, without any glaring effects during the last few weeks of pregnancy, however, the issue has not been formally studied, especially not during earlier pregnancy.  Clonidine does pass into breastmilk in quantities sufficient enough to affect the nursing child and therefore is not recommended during nursing.

In summary, clonidine is a medication that can be used for ADHD.  It has complex side effects, but may be helpful in specific circumstances, particularly if there are other neurological issues at play such as epilepsy or tics, or if the patient requires supplemental therapy for insomnia or ODD.

This article is part of a series on nonstimulants, including bupropion (Wellbutrin), atomoxetine (Strattera),and guanfacine (Intuniv, Tenex).

                                                                                                                  

References:

Connor, Daniel F., Kenneth E. Fletcher, and James M. Swanson. "A Meta-Analysis of Clonidine for Symptoms of Attention-Deficit Hyperactivity Disorder." Journal of the American Academy of Child & Adolescent Psychiatry 38.12 (1999): 1551-559. Web.

Kapvay [package insert] Shinogi, Inc., Florham Park, NJ; February 2013

http://kapvay.com/hcp_index.html.  Accessed May 12, 2015.

This article is part of a series on Non-Stimulant Medications for ADHD.  Other medications included in this series are guanfacine (Tenex/Intuniv), bupropion (Wellbutrin), atomoxetine (Strattera) ,and clonidine (Kapvay) .

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