Centrally acting alpha-2 agonists to reduce blood pressure

Centrally acting alpha-2 agonists include methyldopa, moxonidine and clonidine.

Methyldopa and clonidine are now mainly used in patients with elevated blood pressure (BP) associated with pregnancy.

Do not use moxonidine in patients with heart failure, as it has been associated with an increased mortality rateCohn, 2003Ponikowski, 2016.

If a centrally acting alpha-2 agonists is considered appropriate to reduce BP, use:

1methyldopa 125 mg orally, twice daily, increasing as required up to 500 mg 3 times daily methyldopa methyldopa methyldopa

OR

1moxonidine 200 micrograms orally, daily, increasing as required up to 300 micrograms twice daily moxonidine moxonidine moxonidine

OR

2clonidine 50 micrograms orally, twice daily, increasing as required up to 300 micrograms twice daily. clonidine clonidine clonidine

Note: Do not stop clonidine suddenly.

Do not stop clonidine suddenly because there is a risk of severe rebound hypertension 12 to 36 hours later. If stopping clonidine, halve the dose every 2 to 3 days until the dose is 50 or 75 micrograms daily, then stop. Withdrawal effects can generally be managed by restarting the drug.