Clonidine: Sleepiness

The side effects of clonidine include sleepiness, which is dose-dependent and usually subsides within two to three weeks after the medication is begun. The dose should be started low at 0.05 mg twice a day to avoid excessive sedation and gradually increased as tolerated over two to three weeks to clinical effectiveness (approximately 4-5 micrograms/kg/day for school-aged children). The sleepiness with clonidine can often be helpful in treating bedtime wakefulness or sleep disturbances in children with ADHD (Wilens et al. 1994; Prince et al. 1996). Clonidine is also marketed in a patch form (Catapres TTS), which comes in three strengths and is effective for treatment of ADHD and tics (Comings et al. 1990). It provides a steady level for five to seven days and can be placed in the mid-back area so the child may not easily remove it. Sedation is less in the patch form compared to the tablet form. However, the patch may be irritating to the skin in approximately 30% of patients. Vancenase AQ double strength nasal spray may be sprayed on the back and allowed to dry before placing the patch to decrease skin irritation (Hagerman et al. 1998). In young children, four to six years of age, the Catapres TTS1 patch may be cut in half or smaller to decrease the dosage (Hagerman et al. 1995). The patch should be avoided in the child under four years, who may eat it and thereby cause a significant overdose, which requires hospitalization. When clonidine is discontinued, the dose should be tapered gradually to avoid a significant increase in blood pressure and severe headaches, which may occur with abrupt withdrawal. When the patch is removed, there is a gradual natural taper of the medication from skin stores.

Clonidine: Guanfacine (Tenex)

Guanfacine (Tenex) is chemically related to clonidine, but it has a longer half-life (18 hours vs. 6 hours) and it is less sedating. Hunt et al. (1995) recently reported that guanfacine significantly improved hyperactivity and inattention in 13 children with ADHD. They also mentioned that several patients responded better to a combination of guanfacine and methylphenidate than to either medication alone. Many children with FXS have been successfully treated with guanfacine when the side effects from clonidine, particularly sedation, have been intolerable (Amaria et al. 2001). Guanfacine can also be substituted for clonidine when the child wakes up at 1:00 or 2:00 a.m. after a bedtime dose of clonidine. The longer half-life of guanfacine facilitates a full night of sleep.

This article is not intended to give medical advice for individual cases.  Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals.  Some of the terms will be unfamiliar to those who are not trained in medical fields. *This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002.  It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website. The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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