Oral Clonidine for Maintenance Therapy

Standard Route of Administration

The American Academy of Pediatrics recommends oral clonidine administration for treating neonatal abstinence syndrome, with successful outcomes, in pediatric populations, such as neonatal opioid withdrawal syndrome, with dosing of 1 mcg/kg every 4 hours for scheduled administration or 0.03-0.05 mg/kg every 3-4 hours PRN 2
Transdermal patches (0.1-0.3 mg weekly) are the only other FDA-approved alternative for maintenance therapy, providing steady-state concentrations with less peak-to-trough fluctuation than oral dosing 1

Clonidine must be tapered gradually when discontinuing to avoid rebound hypertension and hypertensive crisis, regardless of route but is particularly important with chronic maintenance therapy 1, 4
Blood pressure and heart rate monitoring is required during treatment, with particular attention to hypotension, especially when initiating therapy 3