Considerations regarding alpha agonists for sleep in children

Pros	Cons
Pharmacokinetics: Rapid absorption, onset action within 1 hour, peak effects 2 to 4 hours Generally well tolerated Widespread usage/acceptability Short half-life (clonidine) creates potential for middle-of-the-night dosing	Little empirical evidence for efficacy, tolerability Effects on sleep architecture: Increased SWS, reduced REM May cause mid-sleep wakening Potential side effects: Hypotension Anticholinergic Irritability, dysphoria Rebound hypertension on discontinuation Exacerbation of partial arousal parasomnias (eg, sleepwalking) Parasomnias Tolerance often develops Narrow therapeutic index; risk of overdose
Bottom line – Little data to support current level of clinician preference, but clinical experience suggests generally effective and well tolerated in ADHD.

ADHD: attention deficit hyperactivity disorder; REM: rapid eye movement; SWS: slow-wave sleep.

Courtesy of Judith A Owens, MD, MPH.

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