Transition from Dexmedetomidine to Enteral Clonidine for ICU Sedation: An Observational Pilot Study

Gagnon, David J.; Riker, Richard R.; Glisic, Elizabeth; Kelner, Andrew; Perrey, Hilary M.; Fraser, Gilles L.

doi:10.1002/phar.1559

Cited by 60 publications

(87 citation statements)

References 42 publications

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“…Two cohort studies evaluated enteral clonidine to transition from dexmedetomidine. The first was a prospective cohort study that included 20 adult patients from a mixed medical, surgical, and neurologic ICU . Overall, 75% of patients had their dexmedetomidine discontinued within 48 hours of clonidine initiation.…”

Section: Clonidinementioning

confidence: 99%

“…Enteral clonidine in adult patients can be initiated at a dose of 0.1–0.3 mg every 6–8 hours and titrated up to 0.4 mg every 6 hours based on clinical response. This dose range is based on the previously discussed data and intravenous clonidine infusion rates that typically range from 0.25–3 μg/kg/hour (0.5–5.75 mg/day in an 80‐kg patient) . If transitioning from a dexmedetomidine infusion, the dexmedetomidine dose should be reduced by 25% with each dose of clonidine administered.…”

Section: Clonidinementioning

confidence: 99%

“…Lower starting doses (e.g., 0.2 mg enterally every 6–8 hrs) of clonidine might be reasonable for patients weighing less than 100 kg, those older than 70 years, or those appropriately sedated with dexmedetomidine at a dose lower than 0.7 μg/kg/hour. Clonidine can be given sublingually (86–99% bioavailability) in patients who have impaired gastrointestinal function or lack of gastrointestinal access . Clonidine patches should be avoided because it takes 3–4 days to reach steady state, and predictable absorption cannot be guaranteed in ICU patients.…”

Section: Clonidinementioning

confidence: 99%

“…Supporting this mechanism is the observation that plasma norepinephrine concentrations increase by 3‐fold at 24 hours and 6‐fold at 48 hours after abrupt clonidine cessation . Tapering off clonidine was reported in three of the five previously discussed adult studies and may be accomplished by increasing the dosing interval every 24–48 hours (e.g., 0.3 mg enterally every 6 hrs for four doses, then 0.3 mg enterally every 8 hrs for three doses, then 0.3 mg enterally every 12 hrs for two doses, then 0.3 mg/day enterally for one dose, and then discontinue) . Reinstitution of the previously tolerated dose may be the best management strategy if withdrawal symptoms emerge.…”

Section: Clonidinementioning

confidence: 99%

“…The first was a prospective cohort study that included 20 adult patients from a mixed medical, surgical, and neurologic ICU. 40 Overall, 75% of patients had their dexmedetomidine discontinued within 48 hours of clonidine initiation. The median maintenance dose of clonidine was 0.3 mg enterally every 6 hours.…”

Section: Pharmacologic Characteristicsmentioning

confidence: 99%

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Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

et al. 2017

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Provision of adequate sedation is a fundamental part of caring for critically ill patients. Propofol, dexmedetomidine, and benzodiazepines are the most commonly administered sedative medications for adult patients in the intensive care unit (ICU). These agents are limited by adverse effects, need for a monitored environment for safe administration, and lack of universal effectiveness. Increased interest has recently been expressed about repurposing older pharmacologic agents for patient comfort in the ICU. Valproate, enteral clonidine, and phenobarbital are three agents with increasing evidence supporting their use. Potential benefits associated with their utilization are cost minimization and safe administration after transition out of the ICU. This literature review describes the historical context, pharmacologic characteristics, supportive data, and practical considerations associated with the administration of these agents for comfort in critically ill adult patients.

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Section: Clonidinementioning

confidence: 99%

Section: Clonidinementioning

confidence: 99%

Section: Clonidinementioning

confidence: 99%

Section: Clonidinementioning

confidence: 99%

Section: Pharmacologic Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

et al. 2017

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Critical care pharmacy practice advancement recommendations on direct patient care activities: An opinion of the American College of Clinical Pharmacy Critical Care Practice and Research Network

Buckley,

Acquisto,

Adams

et al. 2023

J Am Coll Clin Pharm

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An updated position paper on critical care pharmacy services recommends the development of new clinical programs. However, proposed pragmatic strategies for critical care pharmacy practice advancement are lacking. The purpose of this position paper is to develop consensus recommendations aimed at direct patient care activities for the advancement of critical care pharmacy practice. A 24‐member task force of critical care pharmacists, physicians, and nurses participated in a Recommendation Development Phase and Consensus‐building Phase (using a Delphi method) to produce the final critical care practice advancement recommendations. Proposed recommendations of pragmatic medication management opportunities with an advanced scope of practice involving pharmacist prescriptive authority for initiating, modifying, or discontinuing drug therapy and medication monitoring were developed. Task force participants anonymously voted on each proposed recommendation using a five‐point Likert scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Recommendations failing to achieve consensus (≥70% agreement on “strongly agree”/“agree” votes) were revised for subsequent voting. Task force response rates during the first and second voting rounds were 71% (n = 17) and 79% (n = 19), respectively. A total of 57 (93.4%) of the 61 proposed practice advancement recommendations achieved consensus of which 88.5% (n = 54) met consensus after the first round. Consensus recommendations involved the critical care pharmacist initiating (n = 15), modifying (n = 22), or discontinuing (n = 9) drug therapy, and ordering relevant laboratory values or tests to optimize drug therapy (n = 11). One recommendation failing consensus was not revised for additional voting given the impracticality of achieving agreement. Fifty‐seven of the proposed 61 recommendation statements (93%) achieved the consensus threshold after two rounds of voting by an interprofessional expert panel. These recommendations provide a conceptual framework for promoting novel critical care pharmacist prescriptive authority over specific aspects of direct patient care. Implementation challenges and barriers, further described in this paper, must be explored at the institutional level for acceptance.

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Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice

et al. 2016

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Pharmaceutical costs for patients in the intensive care unit (ICU) constitute a large portion of hospital drug budgets. Unfortunately, prices for medications commonly used in the ICU are on the rise for a variety of reasons. In particular, the U.S. Food and Drug Administration's Unapproved Drugs Initiative, generic manufacturers cornering the marketplace, drug shortages, and regulatory device changes are major drivers of pharmaceutical price escalation affecting costs in the ICU. Furthermore, traditional high acquisition cost items still pose challenges to controlling costs. To offer strategies to mitigate the rising costs of pharmaceuticals in the ICU setting, we searched the PubMed/Medline and International Pharmaceutical Abstracts databases and other related sources to identify published cost-saving protocols concerning specific medications that are affected by rising prices or have traditional high acquisition costs. In the absence of specific protocols, we offer possible cost-saving initiatives based on published literature regarding specific agents or based on our own diverse set of experiences. Finally, we review suggested clinical and operational activities at an institutional level to address these rising drug costs in the ICU setting.

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Transition from Dexmedetomidine to Enteral Clonidine for ICU Sedation: An Observational Pilot Study

Abstract: Transitioning from dexmedetomidine to clonidine may be an efficacious, safe, and less costly method of maintaining α2A -receptor agonist therapy in critically ill adults; these results warrant confirmation in expanded studies.

Cited by 60 publications

References 42 publications

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

Critical care pharmacy practice advancement recommendations on direct patient care activities: An opinion of the American College of Clinical Pharmacy Critical Care Practice and Research Network

Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice

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