Clonidine overdose: Report of six cases and review of the literature

Anderson, Ron J.; Hart, Gary R.; Crumpler, Charles P.; Lerman, Mark

doi:10.1016/s0196-0644(81)80350-2

Cited by 62 publications

(32 citation statements)

References 23 publications

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“…Their effects can manifest as bradycardia, atrioventricular (AV) block, AV dissociation, and/or contractile depression. [10][11][12][13][14] The cardiac effects of propranolol are direct, 15 while those of clonidine appear to be mediated via the central nervous system, with prolonged duration lasting for several hours. 16,17 In the present study, we tested the hypothesis that the greater detrimental cardiovascular effects of two sympathoplegic drugs of differing class (i.e., propranolol, a b-adrenergic blocker, and clonidine, an a 2 -adrenergic agonist) combined would be more effectively alleviated by intervention with IFE than epinephrine.…”

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confidence: 99%

The Effect of Fat Emulsion on Hemodynamics Following Treatment With Propranolol and Clonidine in Anesthetized Rats

Macala

Tabrizchi

2014

Academic Emergency Medicine

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Objectives: There is evidence indicating that intravenous fatty emulsion (IFE) is beneficial in restoring circulatory function in certain types of drug overdose. The authors investigated the hemodynamic effects of IFE compared to epinephrine in rats treated with propranolol and clonidine.Methods: Anesthetized male Sprague-Dawley rats were instrumented for measurement of hemodynamics. Rats were randomly assigned to one of six groups (n = 6-8), and each received a clonidine infusion (150 lg/kg) or an equivalent volume of normal saline (0.9% NaCl) over 1 hour. Each rat then received normal saline (1.0 mL/kg) or propranolol (15 to 20 mg/kg). Thereafter, each rat received a dose of IFE (20% solution; 1.0 mL/kg) or epinephrine (2.0 lg/kg) or an equivalent volume of normal saline (1.0 mL/kg).Results: Propranolol alone or with clonidine significantly (p < 0.05) reduced a number of hemodynamic parameters (mean arterial pressure, 37% to 70%; heart rate, 30% to 51%; cardiac contractility [dP/ dtmax], 50% to 67%; and abdominal aortic blood flow, 50% to 83%), while increasing PR intervals (65% to 85%) and QTc intervals (26% to 64%). Saline and epinephrine treatment after propranolol and clonidine combined resulted in no survivors in saline and two out of six in epinephrine group. IFE resulted in significant survival (seven out of eight) for 30 minutes in rats treated with propranolol alone, and propranolol combined with clonidine (seven out of eight).Conclusions: These data demonstrate that IFE is effective for resuscitating rats overdosed on propranolol combined with clonidine. The effect of IFF is unlikely due to a direct positive inotropic or chronotropic action on the myocardium. IFE is also more effective than epinephrine treatment in this paradigm.

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confidence: 99%

The Effect of Fat Emulsion on Hemodynamics Following Treatment With Propranolol and Clonidine in Anesthetized Rats

Macala

Tabrizchi

2014

Academic Emergency Medicine

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“…The appearance of atrioventricular block has been repeatedly described as a side-effect of Clonidine [19,20]. Clonidine leads to sinus slowing and depression of nodal conduction, which is of less importance than those observed following beta-blocker administration.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Clonidine: A Useful and Safety Sedation for Critically Ill Children

Carme¹,

David²,

Sergio³

et al. 2017

Int J Pediatr Res

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Aim: To determine usefulness and safety of intravenous infusion of clonidine in critically-ill children.Methods: Prospective, single-centre observational study from January 2013 to December 2014. PICU of Hospital Sant Joan Déu.Results: 73 patients were enrolled. Median age 7.9 months. Reasons for admission: Respiratory failure (42.5%) and post-cardiac surgery (30.1%). Median PICU length of stay: 14 days. 72 patients were intubated. The median days of clonidine use was 4. Reason for choosing clonidine: To improve prior sedation. We found no major adverse effects but some asymptomatic bradycardia. Conclusions:Clonidine seems to be a good alternative for sedation in critically-ill children. KeywordsClonidine, Sedation, Critically-ill child Opioids and benzodiazepines are the most frequently administered, but long-term use of these drugs is associated with tolerance and withdrawal, suppression of respiratory drive with prolonged ventilation, constipation, and delayed enteric feeding [2,3].Clonidine is a mixed alpha-1 and alpha-2 adrenoceptor agonist with a predominant alpha-2 action [4]. It has a sedative effect mediated by binding to post-synaptic alpha-2 receptors in the pontine locus ceruleus, reducing noradrenergic output and thereby facilitating the firing of inhibitory neurones, mainly, the gamma-aminobutyric acid system. Clonidine has an analgesic action through binding to alpha-2 receptors in the dorsal horn and supra-spinal sites and thereby reduce the release of P substance [1,5,6]. It also causes peripheral vasodilatation and a decrease in systolic blood pressure, heart rate and cardiac output by decreasing sympathetic nervous system activity. Clonidine has varying degrees of affinity for other cellular components called Nonadrenergic Imidazoline Binding Sites (NAIBS). It seems that the hypotensive effect of clonidine would owe more to their affinity for one type of NAIBS, called I1 receptors [7].As clonidine is lipid soluble, it penetrates the bloodbrain barrier to reach the hypothalamus and medulla [5]. It does not require transformation in to another substance prior to its action and about 20-40% is bound to protein. 50% of the drug is metabolized in the liver to inactive metabolites which are excreted in the urine

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“…This phenomenon is recognized in clonidine overdoses as well (20). The hypertension is generally transient and followed by significant hypotension (1,12,20). If this hypertension is to be treated, it is recommended that short-acting agents, such as nitroprusside, be used.…”

Section: Discussionmentioning

confidence: 99%