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Off-label use of clonidine for sedation in Dutch ICUs

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

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.

References

  1. Blaudszun , et al.: Anesthesiology. 2012, 116: 1312-1322. 10.1097/ALN.0b013e31825681cb

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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 (Suppl 1), P415 (2014). https://doi.org/10.1186/cc13605

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  • DOI: https://doi.org/10.1186/cc13605

Keywords

  • Public Health
  • Hypertension
  • Clinical Study
  • Emergency Medicine
  • Clonidine