Effect of clonidine on vomiting and diarrhea associated with ultra-rapid opioid detoxification: a randomized clinical trial

What about clonidine for diarrhoea? A systematic review and meta-analysis of its effect in humans

“…The first step of sensitivity analysis was to include only the 14 studies with patient groups and not healthy volunteers [Fedorak et al 1985; Bretzke, 1987; Gupta and Jha, 1988; Rabbani et al 1989; Baumgartner and Rowen, 1991; Morali et al 1991; Rovera et al 1997; Camilleri et al 2003, 2009; Mcdoniel et al 2004; Buchman et al 2006; Farzam and Najafi, 2009; Bharucha et al 2010, 2014]. Clonidine still had a strong significant effect on diarrhoea with a mean SMD of −1.17 (95% CI −1.74 to −0.60; see Figure 3B), very similar to the previous overall SMD of −1.02.…”

“…Heterogeneity was still present in a similar magnitude (I 2 = 86%) as well as publication bias. When we included only the 10 studies with diagnoses that essentially constitute functional diarrhoea (diabetes, irritable bowel syndrome, faecal incontinence and withdrawal) [Fedorak et al 1985;Bretzke, 1987;Gupta and Jha, 1988;Baumgartner and Rowen, 1991;Morali et al 1991;Camilleri et al 2003Camilleri et al , 2009Farzam and Najafi, 2009;Bharucha et al 2010Bharucha et al , 2014, clonidine still had a significant strong effect on diarrhoea with a mean SMD of −1.04 (95% CI −1.54 to −0.53; see Figure 3C). Furthermore, when we included only the studies with sample size over 10 patients [Gupta and Jha, 1988;Baumgartner and Rowen, 1991;Morali et al 1991;Camilleri et al 2003Camilleri et al , 2009Farzam and Najafi, 2009;Bharucha et al 2010Bharucha et al , 2014, the mean SMD did not change much: −0.99 (95% CI −1.54 to −0.43; see Figure 3D).…”

“…The case reports [Mcarthur et al 1982;Sacerdote, 1986;Zimmermann et al 1986;Roof, 1987;Migliore et al 1988;Scholz et al 1991;Schworer et al 1995] are discussed narratively in a separate section below because of possible high placebo rates and are not included in the meta-analysis. The remaining 24 trials/case series included 10 studies with healthy volunteers (total sample size = 150 participants) [Schiller et al 1985;Baxter et al 1987;Pressman et al 1987;Baumer et al 1989;Gregersen et al 1989;Rubinoff et al 1989;Thollander et al 1997Thollander et al , 1999Mann and Shinkle, 1998;Viramontes et al 2001] and 14 studies (total sample size = 493 patients) with faecal incontinence, irritable bowel syndrome, diabetes, alcohol withdrawal, heroin withdrawal, ultra-rapid opioid detoxification, short bowel syndrome (high output ileostomy or high rectal output), intestinal transplant and cholera patients [Fedorak et al 1985;Bretzke, 1987;Gupta and Jha, 1988;Rabbani et al 1989;Baumgartner and Rowen, 1991;Morali et al 1991;Rovera et al 1997;Camilleri et al 2003Camilleri et al , 2009Mcdoniel et al 2004;Buchman et al 2006;Farzam and Najafi, 2009;Bharucha et al 2010Bharucha et al , 2014. Results regarding statistical analysis of these studies are described in the following.…”