We report a 15-year-old girl with mild intellectual disability and Tourette's syndrome who also had features of hyperkinetic disorder. She had responded poorly to earlier trials of haloperidol and methylphenidate and was on 300 μg clonidine twice a day, 2 mg risperidone daily, 20 mg citalopram daily and 2 mg lorazepam a day. However, these medications were having minimal effects on her behaviour and her tics were also uncontrolled.

With no fixed protocol for clonidine withdrawal an enquiry was made to the hospital pharmacy and the manufacturer who suggested a withdrawal rate of 50 μ g every third day. A week after the withdrawal regimen she was admitted as an emergency to the children's ward with symptoms of blurred vision and high blood pressure. All investigations were normal except for elevated cholesterol and triglyceride levels.

A literature search did not yield any results for a safe rate of clonidine withdrawal to avoid the potentially dangerous side-effects of rebound hypertension in children. The manufacturer, Boehringer Ingelheim, informed us that there were no recommendations for withdrawing clonidine apart from the fact that it has to be withdrawn gradually.

Since clonidine is used in children and young people to treat tic and conduct disorders, sleep disturbances, post-traumatic stress disorder, developmental delay and attention-deficit hyperactivity disorder (Reference Hart-Santora and HartHart-Santora & Hart, 1992; Reference Steingard, Beiderman and SpencerSteingard et al, 1993; Reference Singer, Brown and QuaskeySinger et al, 1995), there is a need for a safe protocol that highlights the need for gradual withdrawal.