Neonatal Drug Therapy Manual

CloNIDine

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated March 5, 2024 - 2:37pm

Alternate Name(s): 
Catapres, Catapres-TTS
Classification: 
Alpha-Adrenergic Agonist
Original Date: 
December 2008
Revised Date: 
August 2016
Indications: 
  • Neonatal narcotic abstinence syndrome
  • Prophylaxis for narcotic and sedative withdrawal syndrome
Administration: 
  • PO: administer with feedings or water to decrease GI upset
  • PR: can be used when PO route not available
Dosage: 
  • PO/PR
    • Initial: 0.5 - 1 mcg/kg/dose every 6 hours. Increase incrementally over several days
    • Range: 0.5 - 4 mcg/kg/dose every 6 hours. Use the lowest effective dose
  • NOTE: Withhold or reduce dose for excessive bradycardia, hypotension.   

Weaning:

Wean clonidine gradually over 1 - 2 weeks to avoid rebound hypertension. One suggested regimen is to decrease by 0.5 - 1 mcg/kg/dose daily until 1 mcg/kg/dose then decrease interval from Q6H to Q8H to Q12H to Q24H as tolerated.  Gradually eliminate daytime dose and then wean to hs dose and then discontinue.

Side Effects: 
  • Cardiovascular: arrythmia, atrioventricular block, bradycardia, hypotension
  • Dermatologic: rash
  • GI: GI upset
Parameters to Monitor: 
  • BP
  • HR
Reconstitution and Stability: 

N/A

Compatibility: 

N/A

Notes: 

Severe rebound hypertension may occur if chronic therapy is abruptly discontinued.  Slowly tapering of clonidine dose is always recommended.

References: 

-Basker S, Singh G, Jacob R.  Clonidine In Pediatrics - A Review.  Indian J Anaesth 2009; 53: 270-80

Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22th Edition. Hudson: Lexi-Comp Inc.; 2015

-Deutsh ES, Nadkarni VM. Clonidine Prophylaxis for Narcotic and Sedative Withdrawal Syndrome Following Laryngotracheal Reconstruction. Arch Otalaryngol head neck surg. 1996 Nov; 22: 1234-38

-Zenck KE, Sills JH, Koeppel RM. Neonatal Medications & Nutrition, 3rd edition. Santa Rosa, California; NICU INK Book Publishers, USA, 2003

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