Innov Clin Neurosci. 2026;23(4–6):5–9.
Dear Editor:
Clonidine is a central acting alpha-2 receptor agonist used for the treatment of psychiatric disorders and sleep difficulties. We report a pediatric patient who developed visual and tactile hallucinations after starting clonidine therapy to address sleep-onset insomnia.
A 6-year-old twin male patient with a history of eczema, asthma, and frequent ear infections now status post-tympanostomy tube placement and adenoidectomy presented to sleep medicine clinic as part of an evaluation for hyperactive and aggressive behaviors. The patient was otherwise cognitively well developed. His sleep history was notable for sleep onset difficulties, taking longer than 30 minutes to fall asleep due to mind racing symptoms, restlessness, and difficulty settling. Other sleep concerns included rare night terrors, leg kicking, and an occasional “tingling” sensation in his legs at the beginning of the night. However, his leg symptoms were not a nightly occurrence and did not consistently interfere with sleep.
His medications included an albuterol inhaler, budesonide, levocetirizine, and fluticasone nasal spray during times of seasonal allergies. He had previously tried melatonin for his sleep difficulties, but this was discontinued due to the concern for worsening aggression. His physical exam was unremarkable. His labs were notable for a ferritin level of 32 ng/mL.
The patient was started on clonidine 0.1 mg at night to address sleep concerns. He slept well on the first night, but on Night 2 of treatment, he developed visual and tactile hallucinations during an awakening in the middle of the night. These hallucinations consisted of bugs crawling on himself, as well as seeing bugs on others.
He presented to the emergency department after the third night of hallucinations and was advised by a psychiatrist to discontinue clonidine therapy. The hallucinations resolved 1 week after stopping the medication. A polysomnography study was also performed around 1 week after stopping clonidine. The study showed normal sleep architecture, normal electroencephalography findings, and no parasomnia activity or significant periodic limb movements.
Clonidine is used for the treatment of sleep difficulties by helping to decrease sleep onset latency. Commonly reported side effects include hypotension, dizziness, and fatigue, with few case reports describing clonidine-associated auditory or visual hallucinations in adults.1–3 To our knowledge, this is the first published case highlighting a pediatric patient with clonidine-associated hallucinations who had both visual and tactile disturbances during middle of the night awakenings. The mechanism for clonidine-induced nocturnal hallucinations is unclear. One possibility is that clonidine is known to reduce and disrupt rapid eye movement (REM) stage sleep, and the patient’s nocturnal hallucinations may be due to disturbances related to this.4 While the patient’s polysomnography study did not show any significant abnormalities in his sleep architecture, it is possible any alterations in sleep architecture normalized after discontinuation of the medication and by the time of the study. Like other reports, clonidine-related hallucinations resolved shortly after discontinuing therapy. While hallucinations appear to be rare, it is important to monitor and council patients about this serious side effect after initiating clonidine.
With regards,
Andrew Ligsay, MD, and Lisa Montagano, MPH, BSN, RN
Dr. Ligsay is with the Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois. Ms. Montagano is with the Division of Pediatric Pulmonary & Sleep Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois.
Funding/financial disclosures. The authors have no relevant conflicts of interest. No funding was received for the preparation of this letter.
Correspondence. Andrew Ligsay, MD
References
- Bestha DP, Madaan V. Clonidine and auditory hallucinations. Innov Clin Neurosci. 2012;9(9):10.
- Brown MJ, Salmon D, Rendell M. Clonidine hallucinations. Ann Intern Med. 1980;93(3):456–457.
- Delaney J, Spevack D, Doddamani S, Ostfeld R. Clonidine-induced delirium. Int J Cardiol. 2006;113(2):276–278.
- Gentili A, Godschalk MF, Gheorghiu D, et al. Effect of clonidine and yohimbine on sleep in healthy men: a double-blind, randomized, controlled trial. Eur J Clin Pharmacol. 1996;50(6):463–465.