Route/Dosage

• PO (Adults and Adolescents B12 yrs): 100 mcg (0.1 mg) bid, ↑ by 100–200 mcg (0.1–0.2 mg)/day q 2–4 days. Usual maintenance dose is 200–600 mcg (0.2–0.6 mg)/day in 2–3 divided doses (up to 2.4 mg/day). Urgent treatment—200 mcg (0.2 mg) loading dose, then 100 mcg (0.1 mg) q hr until blood pressure is controlled or 800 mcg (0.8 mg) total has been administered; follow with maintenance dosing. Opioid withdrawal—300 mcg (0.3 mg)–1.2 mg/day, may be ↓ by 50%/day for 3 days, then discontinued or ↓ by 100–200 mcg (0.1–0.2 mg)/day.

• PO (Geriatric Patients): 100 mcg (0.1 mg) at bedtime initially, ↑ as needed.

• PO (Children): Hypertension—Initial 5–10 mcg/kg/day divided BID-TID, then increase gradually to 5–25 mcg/kg/day in divided doses q 6 hr; maximum dose: 0.9 mg/day. ADHD—0.05 mg/day, then increase q 3–7 days by 0.05 mg/day to 3–5 mcg/kg/day divided TID-QID; maximum dose: 0.5 mg/day. Neuropathic pain—2 mcg/kg/dose q 4–6 hr then increase gradually over days up to 4 mcg/kg/dose q 4–6 hr.

• Transdermal (Adults): Hypertension—Transdermal system delivering 100–300 mcg (0.1–0.3 mg)/24 hr applied every 7 days. Initiate with 100 mcg (0.1 mg)/24 hr system; dosage increments may be made q 1–2 wk when system is changed.

• Transdermal (Children): Once stable oral dose is reached, children may be switched to a transdermal system equivalent closest to the total daily oral dose.

• Epidural (Adults): 30 mcg/hr initially; titrated according to need.

• Epidural (Children): 0.5 mcg/kg/hr initially; titrated according to need up to 2 mcg/kg/hr.

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