(FDA approved in bold)

• Hypertension
  
• Gilles de la Tourette syndrome (GTS)
  
• Tics
  
• Attention deficit hyperactivity disorder (ADHD)
  
• Restless legs syndrome (RLS)
  
• Neuropathic pain
  
• Opioid detoxification
  
• Alcohol withdrawal
  
• Atrial fibrillation
  
• Growth delay
  
• Ulcerative colitis
  
• Hypertensive “urgency”
  
• Menopausal symptoms such as hot flashes
  
• Insomnia
  
• Hyperhidrosis
  
• Anesthesia

• Alpha-2 adrenergic agonist at 2A/B/C receptors Reduces sympathetic output from CNS, which decreases cardiac output, peripheral vascular resistance, and blood pressure. Specifically targets alpha-2 receptors in the brainstem vasomotor center, decreasing presynaptic calcium levels and the release of norepinephrine. May also reduce plasma renin activity and catecholamine excretion
  
• Its effect in GTS and ADHD may be due to actions at the level of the prefrontal cortex

• Hypertension, withdrawal – less than 2 hours
  
• GTS – weeks to months
  
• RLS – days

• In neurologic conditions such as tics, continue to assess effect of the medication and if it is still needed

• GTS/Tics – Neuroleptics are often effective, but their use should be reserved for patients with significant social isolation or embarrassment
  
• RLS – Generally used as an adjunctive agent. Dopamine agonists are more effective

• In hypertension, combine with treatments less likely to affect heart rate or cause orthostasis (angiotensin-converting enzyme inhibitors, diuretics)
  
• Tics and GTS symptoms may change over time. Many patients improve with age. Behavioral and psychological therapies are useful, and education and reassurance are all that is needed in mild cases
  
• Identify and treat comorbid conditions such as ADHD or obsessive compulsive disorder

• Monitor blood pressure and pulse at office visits