Integrated Critical Care Unit Guidelines for the use of Clonidine Infusion Background Clonidine is primarily a centrally acting alpha-2 agonist which reduces blood pressure and heart rate by reducing sympathetic discharge. It also has sedative, analgesic and opioid sparing properties. Clinical indication

Hypertension (licensed) Sedation , alone or as an adjunct (unlicensed) Delirium (unlicensed) Management of opiate and alcohol withdrawal (unlicensed)

Cautions/Contra-indications

Avoid in patients with severe bradyarrhythmia secondary to AV block. Use with caution in mild to moderate bradyarrhythmia. As clonidine can reduce

cardiac output use with care in patients with low cardiac output or impaired left ventricular function.

Should be used with caution in patients with Raynauds and other peripheral occlusive disease.

Not to be used concomitantly with methylphenidate. Must be withdrawn gradually to avoid rebound hypertension (see below).

Adverse effects

Hypotension, bradycardia, AV block, headache, dry mouth. Hallucinations, depression.

Dose and Administration Clonidine is available as 150 microgram in 1 ml ampoules May be given centrally or peripherally Intravenous infusion: Start initial rate at 1mcg/kg/hour. Usual dose by intravenous infusion is 1-2mcg/kg/hour however in exceptional

circumstances doses upto 4mcg/kg/hour may be used. Infusion rate is usually limited by a drop in blood pressure. Blood pressure and heart rate must be monitored closely especially when increasing rate

of clonidine infusion. Care must be taken to maintain the rate within a range where the patient remains haemodynamically stable.

Take 5ml (5 ampoules equating to 750 microgram) and make up to 50ml to give a 15microgram/ml solution Give via syringe pump.

INFUSION RATE (ml/hr) using clonidine 750microgram/50ml Weight (kg)

Infusion rate ml per hr 1 mcg/kg/hr 2 mcg/kg/hr 3mcg/kg/hr 4 mcg/kg/hr

40 2.7 5.3 8.0 10.7 45 3.0 6.0 9.0 12.0 50 3.3 6.7 10.0 13.3 55 3.7 7.3 11.0 14.7 60 4.0 8.0 12.0 16.0 65 4.3 8.7 13.0 17.3 70 4.7 9.3 14.0 18.7 75 5.0 10.0 15.0 20.0 80 5.3 10.7 16.0 21.3 85 5.7 11.3 17.0 22.7 90 6.0 12.0 18.0 24.0 95 6.3 12.7 19.0 25.3 100 6.7 13.3 20.0 26.7

Diluents 0.9% sodium chloride and 5% Glucose. Y Site Compatibilities Fentanyl, morphine, midazolam. Withdrawal of Clonidine

Sudden cessation of clonidine may cause a withdrawal syndrome leading to rebound hypertension associated with symptoms such as headache, flushing, sweating, agitation, nausea.

Reduce dose gradually (0.25-0.5ml/hr) If patient has been on high dose clonidine for several days then taper dose over 2-4

days. For further information please refer to the Medusa IV Guide. References

1. British National Formulary Ed 62 September 2011 2. SPC for Clonidine www.emc.com 2011 accessed January 2011 3. Dollery C (Editor). Therapeutic Drugs, Churchill Livingston (London), 1999;1;c294-

c299 4. Pichot, C et al, Dexmedetomidine and Clonidine:From Second-to-First-Line agents in

the Critical Care Setting? J Intensive Care Med April 27 2011 5. Hall et al. Sedative, analgesic and cognitive effects of clonidine infusions in humans.

British Journal of Anaesthesia 2001 86 (1): 5-11, Written by Critical Care Pharmacy Team March 2012 Review date : March 2015