Clonidine

Clonidine

[patch $7.84, 1 vial for IV administration $2.86]

ADMINISTRATION ROUTES:

• IV, IM, PO, transdermal

ALTERNATIVE NAMES:

• Catapres, Dixarit

ICU INDICATIONS:

1. agitated delirium
2. analgesia
3. hypertension

PRESENTATION AND ADMINISTRATION:

• IV:
  Catapress injection 150mcg in 1ml ampoule. Dilute with 10ml of normal saline and give by slow injection over 5-10 minutes
  Compatible with normal saline only
  Dilute immediately before use and discard any unused solution after opening
  Store at room temperature
• IM:
  Administer neat (not preferred route of administration in ICU)
• PO:
  Dixarit 25mcg tablets (blue)
  Catapress 150mcg tablets (white)
• Transdermal:
  Catapress TTS-1 (0.1mg/24hrs), catapress TTS-2 (0.2mg/24hrs), catapress TTS-3 (0.3mg/24hrs)
  Apply to an area of hairless skin on the upper arm or chest. Use a new site for each patch. One patch lasts for a week.

DOSAGE:

• IV:
  15mcg IV PRN up to maximum of 150mcg or more if tolerated
• PO:
  75mcg daily increased as required to up to 900mcg/day.

  Note: rarely indicated by this route in ICU patients.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

• PO / IV:
  1-5mcg/kg/dose up to 8 hourly
  see PRECAUTIONS Paediatric use

CLINICAL PHARMACOLOGY:

• Clonidine is a centrally acting alpha-2 agonist.

CONTRAINDICATIONS:

1. hypersensitivity to clonidine
2. bradycardia

WARNINGS

• Hypotension
  Because severe hypotension may follow the administration of clonidine, it should be used with caution in all patients. It is not recommended in most patients with severe cardiovascular disease or in those who are otherwise hemodynamically unstable. The benefit of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension.

PRECAUTIONS

• General:
  Withdrawal of clonidine may lead to rebound hypertension. If this occurs, clonidine should be reinstituted and withdrawn more slowly.
• Laboratory Tests:
  No tests in addition to routine ICU tests are indicated
• Drug/Laboratory Test Interactions:
  None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• If a patient receiving clonidine is also taking tricyclic antidepressants, the effect of clonidine may be reduced, thus necessitating an increase in dosage. Clonidine may enhance the CNS-depressive effects of alcohol, barbiturates or other sedatives.

ADVERSE REACTIONS

• Nervous system:
  Excessive sedation, confusion, hallucinations
• Cardiovascular system:
  Hypotension, bradycardia, heart block
• Dermatological:
  Rash, local skin reaction (transdermal)
• Gastrointestinal:
  Constipation