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Off-label use of clonidine for sedation in Dutch ICUs
Critical Care volume 18, Article number: P415 (2014)
Clonidine is an α2-agonist, licensed in most countries for treatment of hypertension. Other pharmacologic characteristics of α2-agonists are sedation, hypnosis, anxiolysis, sympatholysis, and analgesia . Because of these central nervous effects, clonidine can be used off-label to augment sedation and delirium treatment. To our knowledge there have been no publications evaluating the efficacy and safety of clonidine in ventilated critically ill adults. A survey in German ICUs showed that clonidine was used for sedation in 62% of units . We undertook an enquiry to investigate the off-label use of clonidine in Dutch ICUs.
An inventory was sent by email to 25 ICUs in the Netherlands, determined by the difficulty to identify a contact person.
The response rate was 56%. The results are summarized in Table 1. Clonidine was used in all 14 responding ICUs; in 36% this use was reported as often. Licensed use (for hypertension) was 50%. Indications for off-label use were: substance withdrawal (50%), delirium (71%), and sedation (29%). The route of administration was intravenous in all cases. Nine ICUs reported the use of a loading dose, irrespective of indication, varying from 10 to 150 μg, median 150 μg. Ten ICUs reported the use of continuous infusion, varying from 10 to 100 μg/ hour, median 50 μg/hour.
Off-label use of clonidine for sedation and treatment of withdrawal symptoms and delirium was common practice in Dutch ICUs. There was a wide range of dosing regimens: infusion schedules varied 10-fold and loading doses 15-fold. Clinical studies are required to establish the safety and efficacy of clonidine in the ICU setting.
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Van der Valk, J., Zeeman, M., Arbouw, M. et al. Off-label use of clonidine for sedation in Dutch ICUs. Crit Care 18, P415 (2014). https://doi.org/10.1186/cc13605
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