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Rx pill bottles and pills: What can I take instead of clonidine?
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Clonidine alternatives: What can I take instead of clonidine?

Clonidine doesn't work for everyone. Diovan, hydrochlorothiazide, Norvasc, Toprol XL, and Intuniv are some clonidine alternatives. Get the full list here.
Chad Shaffer, MD, medical writer and reviewer for SingleCare
By | Oct. 11, 2022

Compare clonidine alternatives | Diovan | Hydrochlorothiazide | Norvasc | Toprol XL | Intuniv | Natural alternatives | How to switch meds

Clonidine is a unique drug with an unusual set of Food and Drug Administration (FDA) indications that includes treatment of high blood pressure in adults and attention deficit hyperactivity disorder (ADHD) in children. Despite its FDA-approved uses, clonidine is not a first-line therapeutic for either condition, and for good reason. More effective and better tolerability options exist for both hypertension and ADHD. If you or your child is taking clonidine, you are right to question whether there might be a more suitable alternative. Our objective will be to introduce you to other options, in order for you to sit down with your healthcare provider and discuss the alternatives.

RELATED: What is clonidine?

What can I take in place of clonidine?

Clonidine stimulates alpha-2 adrenergic receptors in the central nervous system (CNS) resulting in reduced levels of the adrenaline hormone norepinephrine in the bloodstream. Therefore, blood vessels relax with this alpha agonist action, which explains the blood pressure lowering effect. The results can be profound with adrenergic agonists like clonidine. However, other antihypertensive mechanisms may be more predictable and less prone to problems. These include angiotensin II receptor blockers, angiotensin converting enzyme inhibitors, beta blockers, calcium channel blockers, diuretics (water pills), and direct vasodilators.

Clonidine’s mechanism of action in ADHD is not known, but both clonidine and another alpha-2 agonist, guanfacine, have a niche in ADHD care. They function as alternatives to CNS stimulants which are more effective than alpha-2 agonists but may have intolerable side effects. Some potential side effects of clonidine may include dizziness, lightheadedness, fainting, and constipation. If neither of these categories is working out, selective norepinephrine reuptake inhibitors (SNRIs) can be called on. Clearly, you have some drug class options to choose from, but you will want to know more before deciding whether to switch from clonidine.

Compare clonidine alternatives
Drug name Uses Dosage Savings options
Clonidine hydrochloride Hypertension 0.1 to 0.4 mg twice daily Clonidine coupons
Kapvay (clonidine extended release) Pediatric ADHD 0.1 to 0.4 mg once daily Kapvay coupons
Catapres TTS (clonidine transdermal) Hypertension 0.1 to 0.6 mg/day with patch changed weekly Catapres TTS coupons
Chlorthalidone Hypertension, peripheral edema (swelling) 12.5 to 100 mg once daily Chlorthalidone coupons
Hydrochlorothiazide (HCTZ) Hypertension, peripheral edema 12.5 to 50 mg once daily (higher doses up to 200 mg may used for edema) Hydrochlorothiazide coupons
Diovan (valsartan) Hypertension, congestive heart failure (CHF) with low ejection fraction (EF), left ventricular dysfunction (reduced heart squeeze) after MI 80 to 320 mg once daily (or divided into two doses) Diovan coupons
Diovan HCT (valsartan/HCTZ) Hypertension 80 mg/12.5 mg to 320 mg/25 mg once daily Diovan HCT coupons
Zestril (lisinopril) Hypertension, CHF with low EF, acute MI 2.5 to 40 mg once daily Zestril coupons
Zestoretic (lisinopril/hydrochlorothiazide) Hypertension 10 mg/12.5 mg, 20 mg/12.5 mg, or 20 mg/25 mg once daily Zestoretic coupons
Norvasc (amlodipine) Hypertension, coronary artery disease (CAD) 2.5 to 10 mg once daily Norvasc coupons
Toprol XL (metoprolol extended release) Hypertension, angina, CHF with low EF 25 to 400 mg once daily Toprol XL coupons
Hydralazine Hypertension 10 to 50 mg four times daily Hydralazine coupons
Cardura (doxazosin) Hypertension, benign prostatic hypertrophy (BPH, enlarged prostate) 1 to 16 mg once daily (or maximum of 8 mg for BPH) Cardura coupons
Intuniv (extended release guanfacine) Pediatric ADHD Start 1 mg once daily and adjusted as needed up to a max dose determined by weight Intuniv coupons
Focalin XR (extended release dexmethylphenidate) ADHD 5 to 30 mg once daily for children over 6 years Focalin XR coupons
Vyvanse (lisdexamfetamine) ADHD 30 to 70 mg once daily in children over 6 years Vyvanse coupons

Other alternatives to clonidine

Top 5 clonidine alternatives

The following are some of the most common alternatives to clonidine.

1. Diovan

Angiotensin II receptor blocker (ARBs), such as Diovan, and ACE inhibitors, like Zestril are popular first-line choices for blood pressure management. These two classes of antihypertensives are highly favored for those with concurrent hypertension and diabetes mellitus. ARBs and ACE inhibitors have similar mechanisms and offer cardiovascular and renal benefits. You may like an ARB better, based on their much lower incidence of cough side effects than ACE inhibitors. 

Diovan is a commonly used ARB, partly because its generic form valsartan is readily found in combination with other antihypertensives. Valsartan’s combination pill options include coupling it with HCTZ (Diovan HCT), amlodipine (Exforge), and both HCTZ and amlodipine (Exforge HCT).

In contrast, clonidine is often reserved for resistant cases of hypertension or emergencies when rapid blood pressure reduction is needed. The reluctance to use clonidine more often is partly based on the solid evidence supporting other options like ARBs and partly based on the serious side effects of clonidine. Blood pressure can rebound to high levels if a clonidine dose is missed, and the sudden blood pressure spike could precipitate a cardiac complication. Diovan, like all ARBs, has a more gradual onset of action when started and offset of action when stopped. 

2. Hydrochlorothiazide

Thiazide diuretics are another category of antihypertensive that have support from national guidelines. Hydrochlorothiazide and chlorthalidone are the typical choices from the thiazide class. They have a gradual onset and offset of action. They help with peripheral edema (swelling in the lower legs), thanks to their diuretic action which helps to eliminate fluid. 

Although thiazides have these advantages in comparison to clonidine, the downside of diuretics must be considered. Adverse effects include the potential for electrolyte disturbances, like hypokalemia (low potassium) or hyponatremia (low sodium), and gout attacks. These detracting characteristics could mean that they are not the right choice for you.

RELATED: Hydrochlorothiazide side effects and how to avoid them

3. Norvasc

Norvasc is a brand name dihydropyridine calcium channel blocker, with the potential to lower blood pressure in a timely manner and yet not run the risk of rebound hypertension upon discontinuation. It also avoids electrolyte problems. No wonder they are another first-line option for hypertension treatment. Other dihydropyridine calcium channel blockers include Nifedical XL, felodipine ER, and isradipine. Please note that you may want to steer clear of this antihypertensive category if you have a tendency for lower leg swelling; edema is one of the common side effects of the class.

4. Toprol XL

Toprol XL, Tenormin, Inderal LA, Coreg, Coreg CR, bisoprolol, and Trandate are members of the beta blocker class, another type of blood pressure medication.They are commonly chosen as an antihypertensive for those with coinciding heart disease. Their heart rate lowering effect is a benefit to those with coronary artery disease or heart rhythm problems like atrial fibrillation.Otherwise, beta blockers are a second-line option due to a potential to create withdrawal symptoms when stopped suddenly, similar to clonidine. Despite this pitfall, they are still preferable to clonidine in many circumstances.

5. Intuniv

The aforementioned top alternatives all pertain to hypertension management, but if you are in the position of looking for an alternative medication for your child’s ADHD, Intuniv (extended-release guanfacine) is an option that would make sense. Like clonidine, guanfacine is available as an extended-release tablet for use in ADHD. Stimulants like Vyvanse and Focalin XR are more effective than alpha-2 agonists, but it is not uncommon to have a contraindication or unacceptable side effect with stimulants, like loss of appetite. Intuniv and Kapvay (extended-release clonidine) are non-stimulant options for ADHD care. They also can cause drowsiness, which may be helpful for those with insomnia along with ADHD. Of the two, Intuniv may be better tolerated, having a lower incidence of dry mouth and sedation than Kapvay. Both uncommonly cause hypotension (low blood pressure), but they have the potential for withdrawal if stopped abruptly.

Natural alternatives to clonidine

You can certainly look at non-pharmaceutical options too. Blood pressure-lowering can sometimes be achieved by natural means. Weight loss and exercise should be considered. Dietary modifications of potential value include salt restriction and the more involved Dietary Approaches to Stop Hypertension diet, emphasizing fruits, vegetables, and low-fat dairy products, along with less saturated and total fats.

Vitamins and supplements may also help with blood pressure management. Potassium, magnesium, fish oil, fiber, protein, and folate have all shown some promise in blood pressure reduction. Interestingly, pomegranate juice seems to lower blood pressure somewhat, possibly by inhibiting angiotensin converting enzymes. No supplement is without risk though. Getting medical advice from your healthcare provider is essential to see if any vitamin, supplement, or lifestyle change is safe.

How to switch to a clonidine alternative

The prep work is complete. You now have some ideas about alternatives to clonidine. The next step is to get an appointment with your prescribing healthcare provider. Take along a list of your over-the-counter drugs, antidepressants, and other prescription medications to reconcile with the list that the provider keeps and to have them look for drug interactions. By the conclusion of the appointment, you should be comfortable with a plan to either more forward with clonidine or switch to another option.