Trends and Toxic Effects From Pediatric Clonidine Exposures

Abstract

While most of the clonidine exposures resulted in minimal toxic effects, serious toxic effects and death can occur. The trend toward increasing the number of exposures in children, especially with evidence of toxic effects in children receiving clonidine therapeutically, is cause for concern.

Toxicity from a clonidine suspension

“…However, clonidine toxicity may present with a number of atypical effects, including tachypnea and agitation. Hypertension may be present early in the course and hypotension may not develop [6,14].…”

“…Counseling caretakers on the correct method of administration, training on the use of dispensing devices, warning about the possibility of dose errors and to be alert for new prescriptions that appear to be different in appearance or taste from previously prescribed medicine, and carefully considering a drug's indications and risk-to-benefit ratio may all help to reduce the incidence and severity of overdoses [13,14]. …”

Exposições tóxicas agudas em crianças: um panorama

“…40 Clonidine is an α 2 -agonist derived from imidazoline, used as central antihypertensive. 42 As it is opioid-like, clonidine has been indicated for the treatment of patients with opioid dependency. [42][43] AAPCC-TESS data (1993)(1994)(1995)(1996)(1997)(1998)(1999) show a significant increase in clonidine exposure in children, related to an increase in the prescription of this drug for the management of attention deficit hyperactivity d i s o r d e r .…”

“…42 As it is opioid-like, clonidine has been indicated for the treatment of patients with opioid dependency. [42][43] AAPCC-TESS data (1993)(1994)(1995)(1996)(1997)(1998)(1999) show a significant increase in clonidine exposure in children, related to an increase in the prescription of this drug for the management of attention deficit hyperactivity d i s o r d e r . 4 2 C l o n i d i n e p o i s o n i n g c a u s e s c l i n i c a l m a n i f e s t a t i o n s t h a t r e s e m b l e t h o s e o f t o p i c a l decongestants containing imidazoline derivatives, 44 with rapid onset of action, 30 to 60 minutes after exposure.…”

“…4 2 C l o n i d i n e p o i s o n i n g c a u s e s c l i n i c a l m a n i f e s t a t i o n s t h a t r e s e m b l e t h o s e o f t o p i c a l decongestants containing imidazoline derivatives, 44 with rapid onset of action, 30 to 60 minutes after exposure. 9,42 Common clinical signs in children include central nervous system depression, hypothermia, bradycardia, miosis, and respiratory depression, which develop when a dose of clonidine greater than 10 µg/kg is ingested. 9 Treatment is based on supportive care.…”