Is it a good practice to prescribe clonidine to take as needed for occasional severe blood pressure elevations?

Prescribing as needed clonidine is not part of my routine BP management. If the BP is uncontrolled consistently then long-acting medications can be uptitrated or dose adjusted. As needed clonidine may be helpful in the initial evaluation period or when making medications changes. It is important for patients to understand that occasional BP spikes can be normal (in the setting of pain, migraine headache, or exercise, for example) and do not cause a stroke. It is also helpful to confirm appropriate BP measurement technique at home, when prescribing as needed medications.

The side effects (dry mouth, somnolence, fatigue), frequent dosing, and potential rebound hypertension tend to work against BP control when using clonidine, even as a prn.

Very seldom, I have used oral clonidine. It is short acting and requires to dose every 8 hours or 6 hours. Compliance is poor at best. The patches work well. Most patients use the 0.2mg patches without major side effects and good BP control.