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100 Rohde, Buitelaar, Gerlach & Faraone Clonidine has been less well studied as a treatment for ADHD and is only licen- sed for use in the USAwhich is also the only country to have an extended release for- mulation of clonidine. In other countries clinicians may use immediate release clo- nidine, usually as an add on medication, but in some countries where other ADHD medications are not available it may be used as a monotherapy. It is difficult to give firm advice about titration and dosing as this has not been well studied. Starting do- ses are usually around 0.1mg/day increasing up to around 0.3mg/day. One problem with immediate release clonidine is the short duration of action and it would require at least four time a day dosing to achieve coverage across the day. When using cloni- dine similar precautions to those described for guanfacine should be followed. Note that clonidine and guanfacine should never be used in combination. MONITORING ONGOING TREATMENT AND SIDE EFFECTS Having established and stabilized an effective and optimized medication treat- ment, it is important to put a system in place to monitor ongoing treatment. Whilst a proportion of patients will continue to do well with minimal attention, many will require closer monitoring, either to ensure clinical response continues to be optimal or to minimize the impact of adverse effects. Whilst it is also essential to monitor and manage comorbidities, this is beyond the scope of the current chapter and we will restrict our discussion to the impact of comorbidities on medication treatments (see section “Special circumstances”). Several studies including the influential Multimodal Treatment of ADHD (MTA) study have reported that the long-term outcomes for ADHD treated in a community are much less positive than those reported in short term clinical trials. 21,22 We have argued that this is likely to be due to the reduced focus on adjusting treatment according to accurately measured clinical outcomes in routine prac- tice. 23 As with chronic physical illnesses like diabetes, asthma and hypertension, close monitoring of psychiatric symptoms can significantly improve outcomes. 24 There is preliminary evidence that this is also the case for ADHD. 9 We therefore Link in this https://www.additudemag.com/ straight-answers-are-medications- safe/