Volume 18 Supplement 1

34th International Symposium on Intensive Care and Emergency Medicine

Open Access

Off-label use of clonidine for sedation in Dutch ICUs

  • J Van der Valk1,
  • M Zeeman1,
  • M Arbouw1 and
  • H Van den Oever1
Critical Care201418(Suppl 1):P415

https://doi.org/10.1186/cc13605

Published: 17 March 2014

Introduction

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 [1]. 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 [2]. We undertook an enquiry to investigate the off-label use of clonidine in Dutch ICUs.

Methods

An inventory was sent by email to 25 ICUs in the Netherlands, determined by the difficulty to identify a contact person.

Results

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.
Table 1

Indication and doses of clonidine used in Dutch ICUs

IC levela

Clonidine use

Indication

Loading dose tμg)

Continuous infusion dose μ/hour)

3

Often

Hypertension sedation

ns

ns

3

Often

Hypertension withdrawal; hypertension delirium; sedatior

40 to 12C

10 to 80

3

Often

Substance withdrawal; sedation

150

50

3

Often

Substance withdrawal

75 to 150

50

3

Often

Substance withdrawal; hypertension; delirium

10

40 to 100

3

Sometimes

Delirium

ns

30 to 100

3

Sometimes

Hypertension; delirium

150

ns

3

Sometimes

Substance withdrawal; delirium

ns

40

2

Sometimes

Substance withdrawal; delirium

ns

20 to 50

2

Sometimes

Hypertension; sedation

150

40

2

Sometimes

Substance withdrawal; hypertension; delirium

150

12 to 25

1

Sometimes

Hypertension; delirium

150

ns

1

Sometimes

Delirium

50

50 to 100

1

Sometimes

Delirium

ns

ns

ns, not specified. aLevel of ICU care, with level 3 being the most advanced.

Conclusion

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.

Authors’ Affiliations

(1)
Deventer Hospital

References

  1. Blaudszun , et al.: Anesthesiology. 2012, 116: 1312-1322. 10.1097/ALN.0b013e31825681cbView ArticlePubMedGoogle Scholar
  2. Martin : Crit Care. 2005, 9:1: 17-23.Google Scholar

Copyright

© Van de et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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