ADMINISTRATION ROUTES:
IV, IM, PO, transdermal
ALTERNATIVE NAMES:
Catapres, Dixarit
ICU INDICATIONS:
- Agitated delirium
- Analgesia
- Hypertension
PRESENTATION AND ADMINISTRATION:
IV:
Catapress injection 150 mcg in 1 mL vial
Dilute with 10 mL of Normal saline and give by slow injection over 5-10 minutes. Compatible with Normal saline only. Dilute immediately before use and discard any unused solution after opening. Store at room temperature
IM:
Administer neat (not preferred route of administration in ICU)
PO:
Dixarit 25 mcg tablets (blue) Catapress 150 mcg tablets (white)
Transdermal:
Catapress TTS-1 (0.1 mg/24 hrs), Catapress TTS-2 (0.2 mg/24 hrs), Catapress TTS-3 (0.3 mg/24 hrs)
Apply to an area of hairless skin on the upper arm or chest. Use a new site for each patch. One patch lasts for a week.
DOSAGE:
IV:
15 mcg IV PRN up to maximum 150 mcg or more if tolerated
Transdermal:
Apply patch of between 0.1-0.3 mg/24 hr. Change once weekly
PO:
75 mcg daily increased as required to up to 900 mcg/day
Note: rarely indicated by this route in ICU patients
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
PO / IV:
1-5 mcg/kg/dose up to TDS
see PRECAUTIONS: Paediatric use
CLINICAL PHARMACOLOGY:
Clonidine is a centrally acting alpha-2 agonist
CONTRAINDICATIONS:
- Hypersensitivity to clonidine
- Bradycardia
WARNINGS:
Hypotension:
Because severe hypotension may follow the administration of clonidine, it should be used with caution in all patients. It is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension
PRECAUTIONS:
General:
Withdrawal of clonidine may lead to rebound hypertension. If this occurs, clonidine should be reinstituted and withdrawn more slowly
Paediatric use:
The use and safety of clonidine in children and adolescents has little supporting evidence in randomised controlled trials so is not recommended for use in this population
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None noted
IMPORTANT DRUG INTERACTIONS IN ICU:
If a patient receiving clonidine is also taking tricyclic antidepressants, the effect of clonidine may be reduced, thus necessitating an increase in dosage. Clonidine may enhance the CNS-depressive effects of alcohol, barbiturates or other sedatives
ADVERSE REACTIONS:
Nervous system:
Excessive sedation, confusion, hallucinations
Cardiovascular system:
Hypotension, bradycardia, heart block
Dermatological
Rash, local skin reaction (transdermal)
Gastrointestinal:
Constipation