Clonidine Use in Renal Impairment

Monitoring and Safety

• The European Heart Journal recommends monitoring blood pressure response closely after initiation and with each dose adjustment, and checking for common side effects including sedation, dry mouth, and bradycardia 1
• The European Heart Journal and Kidney International suggest that first-line therapy for CKD with hypertension should be RAS inhibitors (ACE inhibitors or ARBs), particularly in patients with albuminuria, with a target blood pressure of 130-139 mmHg systolic for most patients 2, 3, 4

Treatment Algorithm

• The European Heart Journal and Kidney International recommend a target blood pressure in CKD of 130-139 mmHg systolic for most patients, or 120-129 mmHg for those with eGFR >30 mL/min/1.73 m² if tolerated, with clonidine typically reserved for resistant hypertension after failure of preferred agents 2, 3, 4
• Praxis Medical Insights recommends avoiding clonidine in bilateral renal artery stenosis 5
• Praxis Medical Insights suggests that clonidine is typically reserved for resistant hypertension after failure of preferred agents (RAS inhibitors, calcium channel blockers, thiazide diuretics, and spironolactone) 1