Clonidine for Anxiety Treatment

Introduction to Clonidine Use

• The American Academy of Child and Adolescent Psychiatry notes that α-agonists, such as clonidine, are sometimes used for management of anxiety in children with intellectual disability/developmental disorders, but there are no trials investigating this specific indication 1
• Clonidine is not FDA-approved for anxiety disorders and should not be used as a primary treatment for anxiety; SSRIs remain the evidence-based first-line therapy 1

Special Considerations for Clonidine

• For patients with ADHD and comorbid anxiety, treating the ADHD with stimulants first is recommended, and if anxiety persists, SSRIs should be added rather than switching to clonidine 2
• The American College of Cardiology is not mentioned, however, cardiovascular monitoring is required when using clonidine, including obtaining baseline blood pressure and heart rate before initiation, then monitoring at each dose adjustment 1

Safety and Efficacy

• Clonidine must be tapered to avoid rebound hypertension, and common adverse effects include somnolence, fatigue, headache, bradycardia, hypotension, and clinically insignificant ECG changes 1, 3
• For primary anxiety disorders, use SSRIs as first-line treatment based on established evidence in youth and adults, and clonidine should only be considered when first-line treatments have failed or are contraindicated 1