Experience with using intravenous clonidine hydrochloride in the critical care unit of a tertiary hospital in Spain
Background Clonidine hydrochloride is an α-2 agonist whose approved indication in the summary of product characteristics is as an antihypertensive; nevertheless other indications could be possible.
Purpose To examine the ‘off label’ indications of clonidine in critical care patients on mechanical ventilation, in a tertiary hospital. To describe the procedure to obtain intravenous clonidine hydrochloride in our hospital, since it is not marketed in Spain.
Materials and methods Retrospective study of the use of intravenous clonidine in continuous infusion, for critically-ill patients, in the first six months of 2010. The Selene and Picis programmes were used to analyse computerised clinical histories.
Results A total of 18 patients were treated with clonidine. In 16.7% of the cases, it was used as antihypertensive, and in the remaining 83.3% cases, its use was ‘off label’. In 33.3% of the cases, it was used to control withdrawal symptoms, in 27.8% to prevent withdrawal when removing sedation, in 16.7% to contribute to sedation and in 5.5% to treat delirium. The range of doses used in intravenous perfusion was 0.3-9 mcg/Kg/h. The average length of treatment was 6.8 days. In 94.4% of patients, it was used in combination with other sedatives; it was used as monotherapy in only 5.5% of the cases. It was combined with propofol in 77.7% of cases, with midazolam in 33.3%, with fentanyl in 22.2%, with remifentanil in 22.2% and with morphine in 11.1% of cases. 27.7% of the patients responded with hypotension and 0.05% with bradycardia. Acquisition of intravenous clonidine in Spain must be through importation from abroad or by requesting it as a ‘special’ from accredited pharmacies. The authors acquire it produced in small amounts in this way in concentrations of 0.15 mg/ml and 0.4%, 5 ml ampoules.
Conclusions In our patients, intravenous clonidine hydrochloride has been shown to be a useful drug for controlling tolerance to, or withdrawal from, sedative and analgesic drugs in critically-ill patients undergoing mechanical ventilation.