Moxonidine

Moxonidine is a centrally acting antihypertensive that works by stimulating imidazoline I1 receptors in the brainstem, reducing sympathetic nervous system activity and lowering blood pressure. It is generally used as an add-on therapy when first-line antihypertensives do not provide adequate control. Moxonidine may have metabolic advantages, including modest improvements in insulin sensitivity, making it a consideration for hypertensive patients with metabolic syndrome.

How to Take Moxonidine

Take one moxonidine tablet once daily in the morning, with or without food. Start at a low dose (0.2 mg) and increase if needed after three weeks, typically to 0.4 mg once daily or split into two doses. The maximum daily dose is 0.6 mg.

Do not stop moxonidine suddenly, especially if you are taking it alongside a beta-blocker. Abrupt withdrawal can cause a rebound rise in blood pressure. If you need to stop, the dose should be reduced gradually.

Start at 200 mcg once daily in the morning. If blood pressure is not adequately controlled after three weeks, increase to 400 mcg daily (as a single dose or divided into two doses). Maximum: 600 mcg daily in divided doses.

Common Side Effects

Common side effects include:

• Dry mouth (most common, often improves with time)
• Headache
• Dizziness
• Fatigue
• Nausea

Most side effects are mild and tend to diminish after the first few weeks of treatment. Moxonidine acts centrally to lower blood pressure and can cause sedation. Avoid driving or operating machinery until you know how it affects you.

Do not stop abruptly, as this may cause rebound hypertension. Taper gradually over two weeks. Avoid in patients with heart failure (NYHA III-IV) or significant bradycardia.

Contraindicated in sick sinus syndrome, sinoatrial or AV block (second or third degree), heart rate below 50 bpm, severe heart failure, severe renal impairment, and severe hepatic impairment.