Can you take clonidine and Strattera together? Navigating Combination Therapies

October 13, 2025 •

3 min read

While standard drug interaction checkers may show no interaction, combining clonidine and Strattera (atomoxetine) is a practice that requires careful medical supervision. Both medications can impact cardiovascular function, necessitating a comprehensive understanding of their combined effects and potential risks.

Quick Summary

Combining clonidine and Strattera (atomoxetine) for ADHD is possible under medical guidance, but requires close monitoring due to overlapping cardiovascular effects. Both non-stimulants affect norepinephrine, so a healthcare provider must manage dosage and assess individual risk before initiating or adjusting treatment.

Key Points

Requires Medical Supervision: Combining clonidine and Strattera should only be done under the strict guidance of a healthcare provider due to overlapping cardiovascular and CNS effects.
Opposing Cardiovascular Effects: Clonidine lowers blood pressure and heart rate, while Strattera can increase them; this necessitates careful monitoring to manage potential orthostatic hypotension or other heart-related issues.
Benefits for Complex ADHD: This combination can be particularly effective for patients with complex ADHD presentations, such as those with co-occurring tics, aggression, or sleep disturbances that aren't fully controlled by a single medication.
Additive Sedation Risk: Both medications can cause drowsiness, and combining them may lead to increased sedation, which can impair daily activities like driving.
Careful Dosage Titration: A doctor will likely start with lower amounts and increase them slowly while monitoring the patient's response and side effect profile, rather than prescribing full amounts of both drugs at once.
Not a Stimulant Combination: Unlike combining a stimulant with an alpha agonist, this combination uses two non-stimulant medications, which may be a suitable alternative for patients sensitive to stimulants.

Understanding the Individual Medications

To understand the nuances of combining clonidine and Strattera, it's crucial to first examine each medication's mechanism of action, purpose, and side effects individually.

Clonidine (Kapvay, Catapres)

Clonidine is a centrally acting alpha-2 adrenergic agonist primarily used to treat high blood pressure, but it is also used for ADHD due to its effects on neurotransmission in the prefrontal cortex. It helps manage symptoms like hyperactivity, impulsivity, aggression, tics, and sleep issues. Common side effects include drowsiness, dry mouth, dizziness, and low blood pressure. Abrupt discontinuation can lead to rebound hypertension.

Strattera (Atomoxetine)

Strattera is a selective norepinephrine reuptake inhibitor (SNRI) that increases norepinephrine in the brain, improving attention, concentration, and impulse control. It is a non-stimulant ADHD medication for both children and adults, with effects that develop over several weeks. Common side effects include nausea, appetite loss, dizziness, and fatigue. Strattera carries a boxed warning about the risk of suicidal thoughts in children and adolescents.

The Rationale for Combination Therapy

Combining medications can be beneficial when a single drug isn't sufficient to manage ADHD symptoms or when co-occurring conditions are present. This approach can help address comorbidities like anxiety, tics, or sleep disorders, enhance treatment efficacy, or provide an alternative for patients who cannot tolerate stimulant side effects.

Potential Interactions and Considerations

Despite some drug interaction checkers showing no direct interaction, combining clonidine and Strattera requires caution due to their effects on the cardiovascular system.

Cardiovascular Effects

Clonidine lowers blood pressure and heart rate, while Strattera can increase them. When used together, careful monitoring is needed for potential additive effects like orthostatic hypotension. Combining clonidine with other drugs affecting heart conduction could lead to bradycardia or other abnormalities.

Neurological Effects

Both medications can cause drowsiness, and combining them may increase this effect. Rare reports of psychosis or unusual behavioral changes have occurred with atomoxetine in combination with other psychoactive medications.

Dosage and Monitoring

A healthcare provider will manage the dosages carefully when combining these medications, often using gradual titration and regular monitoring of blood pressure, heart rate, and overall response.

Comparison of Clonidine and Strattera


Feature	Clonidine (Alpha-2 Agonist)	Strattera (SNRI)
Primary Mechanism	Stimulates alpha-2 adrenergic receptors, reducing sympathetic outflow.	Inhibits norepinephrine reuptake, increasing synaptic norepinephrine.
Effect on ADHD	Reduces hyperactivity, impulsivity, aggression; aids with tics and sleep.	Improves attention, concentration, and impulse control.
Onset of Action	Relatively quick, with sedative effects often notable early on.	Gradual, may take several weeks to see full therapeutic effect.
Cardiovascular Effects	Lowers blood pressure and heart rate; risk of orthostatic hypotension.	Can increase blood pressure and heart rate.
Risk of Dependence	Low potential for abuse or dependence; not a controlled substance.	Low potential for abuse or dependence; not a controlled substance.
Common Side Effects	Dry mouth, drowsiness, dizziness, constipation, sedation.	Nausea, appetite loss, dizziness, fatigue, dry mouth.
Regulatory Warning	Rebound hypertension if stopped abruptly.	Boxed warning for suicidal thoughts in children/adolescents.

Conclusion: Informed Decision-Making is Key

Combining clonidine and Strattera for ADHD is a strategy that can be used by experienced healthcare providers, particularly for complex cases or those who cannot tolerate stimulants. However, it requires careful medical supervision and monitoring due to the potential for overlapping cardiovascular and central nervous system effects. Open communication with a healthcare provider about potential benefits and risks is essential, and strict adherence to prescribed dosages and monitoring schedules is crucial for safety and efficacy. Can Clonidine and Strattera be taken together?

Frequently Asked Questions

Combining clonidine and Strattera is possible but must be done under a doctor's close supervision. Both medications can affect heart rate and blood pressure, so a healthcare provider needs to monitor you carefully to manage potential side effects and ensure safety.

Potential side effects include increased sedation or drowsiness, dizziness, and changes in blood pressure and heart rate due to the opposing cardiovascular effects of the two drugs. Your doctor will monitor you for orthostatic hypotension (a drop in blood pressure when standing).

A doctor might prescribe this combination to address different aspects of ADHD, especially for patients with co-occurring symptoms like aggression, tics, or sleep problems. The combination may also allow for adjustments in the amounts of each drug, potentially reducing individual side effects.

Drug interaction checkers often do not show a direct interaction. However, this is not a guarantee of safety. Both medications have an impact on the cardiovascular and central nervous systems, so their combined effects must be carefully considered by a medical professional.

Your doctor will likely start with lower amounts and gradually increase them while regularly monitoring your blood pressure, heart rate, and overall response to the treatment. Follow-up appointments will also be scheduled to discuss any side effects.

No, you should never stop taking these medications abruptly. Abruptly discontinuing clonidine can cause a dangerous spike in blood pressure (rebound hypertension). Any changes to your treatment plan should be made under a doctor's guidance.

While not as common as a stimulant combined with an alpha agonist, combining two non-stimulants like clonidine and Strattera is a valid strategy for specific patients, especially those who do not tolerate stimulants well. It is a specialized approach reserved for particular clinical needs.