ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Alpha-2 Agonist — Analgesic/Sedative Adjunct Pregnancy: Use with caution — crosses placenta; neonatal hypertension and withdrawal reported

Clonidine (Burns — Analgesia/Sedation Adjunct)

Brand names: Catapres, Dixarit

Adult dose

Dose: Oral: 50–150 mcg every 8–12 hours; IV infusion: 0.3–3 mcg/kg/hour
Route: Oral / IV infusion / Transdermal patch
Frequency: Every 8–12 hours (oral); continuous (IV)
Max: 600 mcg/day
Used as opioid-sparing analgesic adjunct and sedation aid in burns patients. Reduces opioid requirements, attenuates sympathetic hyperactivity, and improves sleep quality. IV infusion for ICU burns sedation; oral/patch for ward-based pain management.

Paediatric dose

Dose: 1–5 mcg/day/kg
Route: Oral / IV
Frequency: Divided 3–4 times daily
Max: 10 mcg/kg/day
Paediatric burns: 1–5 mcg/kg/day in divided doses under specialist guidance.

Dose adjustments

Renal

Reduce dose in severe renal impairment — partially renally excreted.

Hepatic

Caution in hepatic impairment.

Paediatric weight-based calculator

Paediatric burns: 1–5 mcg/kg/day in divided doses under specialist guidance.

Clinical pearls

  • NEVER stop abruptly — rebound hypertension and tachycardia within 8–24 hours (due to upregulated adrenergic receptors). Taper over minimum 1 week.
  • Opioid-sparing effect: clonidine reduces IV opioid requirements by 20–30% in burns patients — useful in opioid-tolerant patients needing dose reduction
  • Transdermal patch (Catapres TTS) useful for patients with limited IV/oral access — provides stable plasma levels with weekly application

Contraindications

  • Severe bradycardia or AV block
  • Sick sinus syndrome
  • Depression (may worsen)

Side effects

  • Bradycardia
  • Hypotension
  • Sedation and drowsiness
  • Dry mouth
  • Rebound hypertension on abrupt withdrawal
  • Depression

Interactions

  • Beta-blockers (additive bradycardia; rebound hypertension if clonidine stopped first — always stop beta-blocker first)
  • TCAs (reduce antihypertensive effect)
  • Opioids (additive sedation and analgesia)
  • Ciclosporin (may increase levels)

Monitoring

  • Blood pressure and heart rate
  • Sedation score
  • Pain scores (NRS)
  • Signs of rebound hypertension on dose reduction

Reference: BNFc; BNF 90; BBA Burns Pain Management Guidelines; BNFc; FICM ICU Sedation Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators