What is clonidine?

Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily.

Clonidine (Catapres tablet/patch, Javadin) is used to treat hypertension (high blood pressure).

The Kapvay brand is an extended-release tablet used to treat attention deficit hyperactivity disorder (ADHD).

Onyda XR is an extended-release oral suspension used to treat ADHD in children 6 years and older.

Clonidine is sometimes given with other medications. Clonidine is also available as a transdermal patch worn on the skin. Do not use two forms of this medicine at the same time.

Warnings

Before you take clonidine, tell your doctor if you have heart disease or severe coronary artery disease, a heart rhythm disorder, slow heartbeats, low blood pressure, a history of heart attack or stroke, kidney disease, or if you have ever had an allergic reaction to a Catapres TTS transdermal skin patch.

Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Before taking this medicine

You should not take this medicine if you are allergic to clonidine.

To make sure clonidine is safe for you, tell your doctor if you have:

• heart disease or severe coronary artery disease;
• a heart rhythm disorder, slow heartbeats;
• high or low blood pressure, or a history of fainting spells;
• a heart attack or stroke;
• pheochromocytoma (tumor of the adrenal gland);
• kidney disease; or
• if you have ever had an allergic reaction to a Catapres TTS transdermal skin patch.

It is not known if clonidine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of clonidine on the baby.

Clonidine may affect fertility in men or women. Pregnancy could be harder to achieve while either parent is using this medicine.

If you are breastfeeding, tell your doctor if you notice somnolence, tiredness, rapid breathing, and poor feeding in the nursing baby.

Catapres is not approved for use by anyone younger than 18 years old. Do not give Kapvay to a child younger than 6 years old.

How should I take clonidine?

Take clonidine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Clonidine is usually taken in the morning and at bedtime. If you take different doses of this medicine at each dosing time, it may be best to take the larger dose at bedtime.

Clonidine may be taken with or without food.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Javadin oral solution is for adults with hypertension and can be taken with or without food.

Tell your doctor if you have a planned surgery.

You may have withdrawal symptoms if you stop using this medicine suddenly. Ask your doctor before stopping the medicine.

Call your doctor if you are sick with vomiting. This is especially important for a child taking clonidine.

If you have high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms.

Store at room temperature away from moisture, heat, and light.

Dosing information

Usual Clonidine Adult Dose for Hypertension

Oral Tablets:

• Initial dose: 0.1 mg orally 2 times a day (morning and bedtime)
• Titration: Increments of 0.1 mg orally per day may be made at weekly intervals to desired response
• Maintenance dose: 0.2 to 0.6 mg orally per day in divided doses
• Maximum dose: 2.4 mg orally per day in divided doses

Comments:
Taking the larger portion of the oral daily dose at bedtime may minimize the transient adjustment effects of dry mouth and drowsiness

Transdermal patches:

• Initial dose: 0.1 mg/24 hr patch applied every 7 days
• Maintenance dose: If, after 1 to 2 weeks, the desired reduction in blood pressure is not achieved, increase the dosage by adding another 0.1 mg/24 hr patch or changing to a larger system
• Maximum dose: Doses above two 0.3 mg/24 hr patches applied every 7 days is usually not associated with additional efficacy

Comments:
-The transdermal patch should be applied to a hairless area of intact skin on the upper outer arm or chest.
-Each new patch should be applied on a different skin site from the previous location.
-If the patch loosens during 7-day wearing, the adhesive cover should be applied directly over the system to ensure good adhesion.
-There have been rare reports of the need for patch changes prior to 7 days to maintain blood pressure control.
-When substituting patches for the oral formulation or for other antihypertensive drugs, physicians should be aware that the antihypertensive effect of the patches may not commence until 2 to 3 days after initial application; therefore, gradual reduction of prior drug dosage is advised. Some or all previous antihypertensive treatment may have to be continued, particularly in patients with more severe forms of hypertension.
Use: For hypertension, alone or in combination with other antihypertensive agents

Javadin Oral Solution:

• Initial dose: 0.1 mg orally twice daily with or without food (morning and bedtime).
• Titrate in increments of 0.1 mg per day at weekly intervals if necessary until the desired response is achieved.
• Usual maintenance dose: 0.2 mg-0.6 mg per day, given in divided doses.

Comments: Store at 20°C to 25°C (68°F to 77°F). Discard unused portion 60 days after first opening. 

Usual Pediatric Dose for Attention Deficit Disorder

Kapvay Extended-release tablets:
6 years and older:
-Initial dose: 0.1 mg orally at bedtime
-Titration: Increase in 0.1 mg/day increments every 7 days until desired response; doses should be administered twice daily (either split equally or with the higher split dosage given at bedtime)
-Maximum dose: 0.4 mg/day in 2 divided doses

Comments:
-May be taken with or without food.
-If a dose is missed, that dose should be skipped and take the next dose as scheduled.
-Tablets should be swallowed whole, and not crushed, chewed, or broken to avoid increasing the rate of drug release.
-When discontinuing therapy, taper daily dose by no more than 0.1 mg every 3 to 7 days.

Use: For the treatment of attention deficit hyperactivity disorder (ADHD) as monotherapy or as adjunctive therapy to stimulant medications.

Onyda XR Extended-release oral suspension
–Children 6 years and older.
-Initial Onyda XR dose: 0.1 mg orally once daily at bedtime with or without food. Dosage may be increased in increments of 0.1 mg per day at weekly intervals.
-Maximum recommended dosage: 0.4 mg once daily at bedtime.
-Comments: Do not substitute Onyda XR for other clonidine products on a mg-per-mg basis because of differing pharmacokinetic profiles.
-When discontinuing: Taper the dose in decrements of no more than 0.1 mg every 3 to 7 days to avoid rebound hypertension.

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include feeling cold, irritable, weak, drowsy, or light-headed, or having weak reflexes, pinpoint pupils, slow heartbeats, shallow breathing, or a seizure.

What should I avoid while taking clonidine?

Avoid drinking alcohol. It may increase certain side effects of clonidine.

Avoid driving or hazardous activity until you know how clonidine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Avoid becoming overheated or dehydrated during exercise and in hot weather.

Clonidine side effects

Get emergency medical help if you have signs of an allergic reaction to clonidine: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• severe chest pain, shortness of breath, irregular heartbeats;
• a very slow heart rate; or
• a light-headed feeling, like you might pass out.

Common clonidine side effects may include:

• drowsiness, dizziness;
• feeling tired or irritable;
• dry mouth;
• constipation, loss of appetite; or
• sleep problems (insomnia), nightmares.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect clonidine?

Using clonidine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

• other heart or blood pressure medications;
• an antidepressant; or
• any other medicine that contains clonidine.

This list is not complete. Other drugs may interact with clonidine, including prescription and over-the-counter medicines, vitamins, and herbal products. 

Clonazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain.

Clonazepam is used to treat certain seizure disorders (including absence seizures or Lennox-Gastaut syndrome) in adults and children.

Clonazepam is also used to treat panic disorder (including agoraphobia) in adults.

Warnings

Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing.

MISUSE OF CLONAZEPAM CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Never share clonazepam with another person. Selling or giving away this medicine is against the law.

Some people have thoughts about suicide while taking clonazepam. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Get medical help right away if you stop using clonazepam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide.

Do not stop using clonazepam without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer.

Before taking this medicine

You should not take clonazepam if you allergic to it or if you have:

• narrow-angle glaucoma;
• severe liver disease; or
• a history of allergic reaction to any benzodiazepine (including alprazolam, diazepam, lorazepam, Valium, Xanax, Versed, and others).

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• kidney or liver disease;
• breathing problems;
• depression, mood problems, or suicidal thoughts or behavior; or
• porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Some people have thoughts about suicide while taking clonazepam. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Tell your doctor if you are pregnant or plan to become pregnant. If you use clonazepam during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks.

Do not start or stop seizure medication during pregnancy without your doctor’s advice. Clonazepam may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Preventing seizures may outweigh these risks. Tell your doctor right away if you become pregnant.

Ask a doctor if it is safe to breastfeed while using this medicine.

Do not give this medicine to a child without medical advice. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old.

How should I take clonazepam?

Take clonazepam exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Your doctor may occasionally change your dose. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

You will need frequent medical tests.

Do not stop using clonazepam suddenly, even if you feel fine. Stopping suddenly may cause increased seizures or unpleasant withdrawal symptoms. Follow your doctor’s instructions about tapering your dose.

Swallow the regular tablet whole, with a full glass of water.

Clonazepam doses are based on weight in children. Your child’s dose needs may change if the child gains or loses weight.

Remove an orally disintegrating tablet from the package only when you are ready to take the medicine. Place the tablet in your mouth and allow it to dissolve, without chewing. Swallow several times as the tablet dissolves.

Your doctor will need to check your progress on a regular basis.

Call your doctor if this medicine seems to stop working as well in treating your seizures or panic attacks.

Seizures are often treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

Store at room temperature away from moisture, heat, and light. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of clonazepam can be fatal if you take it with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing.

Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, or coma.

What should I avoid while taking clonazepam?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how clonazepam will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Clonazepam side effects

Get emergency medical help if you have signs of an allergic reaction to clonazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• new or worsening seizures;
• severe drowsiness;
• weak or shallow breathing;
• unusual changes in mood or behavior;
• confusion, paranoia, nightmares, hallucinations;
• thoughts of suicide or hurting yourself;
• unusual or involuntary eye movements.

Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury.

Common clonazepam side effects may include:

• drowsiness, dizziness;
• feeling tired or depressed;
• memory problems; or
• problems with walking or coordination.

After you stop using clonazepam, get medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions.

Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin.

Ativan (lorazepam) belongs to a class of medications called benzodiazepines. It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain.

Ativan is used in adults and children at least 12 years old to treat anxiety disorders.

Ativan is also used to treat insomnia caused by anxiety or temporary situational stress.

Ativan is sometimes used to treat nausea and vomiting from cancer treatment and to control agitation caused by alcohol withdrawal.

Warnings

Ativan can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. These effects can be fatal.

MISUSE OF ATIVAN CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep this medicine where others cannot get to it.

Lorazepam may be habit-forming and should be used only by the person it was prescribed for. Ativan should never be shared with another person, especially someone who has a history of drug abuse or addiction.

Do not stop using Ativan without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer.

Get medical help right away if you stop using Ativan and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide.

Do not use Ativan if you are pregnant. Lorazepam can cause birth defects or life-threatening withdrawal symptoms in a newborn.

You should not use this medicine if you have narrow-angle glaucoma, severe respiratory insufficiency, myasthenia gravis, or if you are allergic to Valium or a similar medicine.

Before taking this medicine

You should not use Ativan if you have:

• narrow-angle glaucoma; or
• a history of allergic reaction to any benzodiazepine (lorazepam, alprazolam, diazepam, Valium, Xanax, Versed, Klonopin, and others).

To make sure Ativan is safe for you, tell your doctor if you have ever had:

• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;
• drug or alcohol addiction;
• depression, mental illness or psychosis, mood changes, or suicidal thoughts or actions;
• seizures;
• an allergy to aspirin or yellow food dye; or
• kidney or liver disease.

Tell your doctor if you are pregnant or plan to become pregnant. If you use Ativan during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of lorazepam on the baby.

You should not breastfeed.

If you do breastfeed, tell your doctor if you notice drowsiness, feeding problems, or slow weight gain in the nursing baby.

How should I take Ativan?

Take Ativan exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides or instruction sheets. Never use Ativan in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

Never share Ativan with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law.

Do not stop using Ativan without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use.

Store Ativan tablets tightly closed at room temperature, away from moisture and heat.

Keep your medicine in a place where no one can use it improperly.

Dosing information

Usual Adult Dose for Anxiety:

Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

Uses:
-Management of anxiety disorders
-Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Adult Dose for Insomnia:

2 to 4 mg orally once a day at bedtime

Comments:
-The dosage should be increased gradually when needed to help avoid adverse effects.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Use: Management of insomnia due to anxiety of transient situational stress

Usual Geriatric Dose for Anxiety:

Older or debilitated patients:
-Initial dose: 1 to 2 mg orally per day, given in divided doses

-Management of anxiety disorders
-Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Pediatric Dose for Anxiety:

12 years or older:
-Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
-Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

-The daily dosage may vary from 1 to 10 mg/day.
-The dosage should be increased gradually when needed to help avoid adverse effects.
-When higher dosage is indicated, the evening dose should be increased before the daytime doses.
-Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Uses:
-Management of anxiety disorders
-Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Pediatric Dose for Insomnia:

12 years or older: 2 to 4 mg orally once a day at bedtime

Comments:
-For debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended.
-The dosage should be increased gradually when needed to help avoid adverse effects.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of lorazepam can be fatal if you also drink alcohol or use other drugs that cause drowsiness or slow breathing.

Overdose symptoms may include severe drowsiness, confusion, slurred speech, feeling restless, muscle weakness, loss of balance or coordination, feeling light-headed, slow heartbeats, weak or shallow breathing, or coma.

What should I avoid while taking Ativan?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how Ativan will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Ativan side effects

Get emergency medical help if you have signs of an allergic reaction to Ativan: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Lorazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Ativan may cause serious side effects. Call your doctor at once if you have:

• severe drowsiness;
• unusual changes in mood or behavior, being agitated or talkative;
• sudden restless feeling or excitement;
• seizures, depression, thinking problems, thoughts of suicide or hurting yourself;
• confusion, aggression, hallucinations;
• sleep problems (insomnia);
• vision changes; or
• dark urine, or jaundice (yellowing of the skin or eyes).

Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury.

Common Ativan side effects may include:

• dizziness, sedation, drowsiness;
• weakness; or
• feeling unsteady.

You will need frequent blood tests to check your blood counts and liver function.

After you stop using Ativan, seek medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions.

Some withdrawal symptoms may last up to 12 months or longer after stopping Ativan suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin.