Review of Guidelines on Clonidine for Various Indications

Key Messages

What Is the Issue?

• Clonidine is an antihypertensive medication that has been used for a range of health conditions including hypertension, substance use disorders, menopause, restless leg syndrome, migraines, attention-deficit/hyperactivity disorder (ADHD), and Tourette syndrome. The role of clonidine in the treatment of these health conditions is unclear.

What Did We Do?

• To inform decisions around the use of clonidine in various health conditions, we sought to identify and summarize recommendations from evidence-based guidelines.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2014. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included guidelines, and narratively summarized the findings.

What Did We Find?

• We identified 12 evidence-based guidelines that included recommendations on the use of clonidine. We identified 1 guideline on hypertension, 4 guidelines on substance use disorders, 4 guidelines on menopause, 2 guidelines on restless leg syndrome, and 1 guideline on Tourette syndrome. We did not identify any evidence-based guidelines that included recommendations on the use of clonidine for the treatment of ADHD or migraine prophylaxis.
• The included guidelines recommend clonidine for hypertension in pregnant women, management of opioid withdrawal and alcohol withdrawal, and Tourette syndrome.
• The recommendations in the guidelines for menopause were mixed. Two guidelines do not recommend clonidine and 2 guidelines recommend clonidine for the treatment of vasomotor symptoms (i.e., hot flashes) of menopause.
• One guideline does not recommend the use of clonidine for restless leg syndrome in people who are pregnant or lactating and 1 guideline states that there is insufficient evidence to support or refute the use of clonidine in restless leg syndrome.

What Does It Mean?

• The use of clonidine is recommended for some health conditions and is not recommended for others. Due to the inconsistency in recommendations on the use of clonidine for the control of hot flashes in menopause, decision-makers may wish to consider other factors such as patient preferences and availability of other treatment options.
• Future evidence-based guidelines that include recommendations on the use of clonidine for the prevention of migraines, treatment of ADHD and the treatment of hypertension in a broader population would help fill the gaps identified in this report.