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Transitioning Patients From Dexmedetomidine (Precedex) To Enteral Clonidine In The ICU Category: Pharmacotherapy by - November 11, 2016 | Views: 11318 | Likes: 0 | Comment: 0  

Study #2

Transition from Dexmedetomidine to Enteral Clonidine for ICU Sedation: An Observational Pilot Study

This was a single-center, prospective, observational study conducted to test the hypothesis that transitioning adult ICU patients from dexmedetomidine to enteral clonidine is safe, effective, and less costly. A total of 20 patients were evaluated with a median age of 62 years of age. In this study, the transition from dexmedetomidine to enteral clonidine was as follows:

  • Dexmedetomidine doses less than 0.7 mcg/kg/hour, body mass less than 100 kg, or older patients: clonidine initiated at 0.2 mg every 6 hours
  • Dexmedetomidine doses of 0.7 mcg/kg/hour or higher, body mass 100 kg or more, or younger patients: clonidine was initiated at 0.3 mg or more every 6 hours
  • Dexmedetomidine was generally reduced by 25% of baseline within 6 hours of each clonidine dose if agitation requiring rescue medication did not occur. 

Efficacy: Ten (50%) patients were successfully transitioned from dexmedetomidine within 24 hours of their first clonidine dose and 15 (75%) transitioned with 48 hours.

Safety: No statistically significant differences in safety data

Summary

Both of the mentioned studies above had few patients included in their analysis with only one study describing a dosing strategy for initiating and tapering off clonidine. Based on the data from these 2 studies, it is not completely clear on what exact dose of clonidine to initiate in a patient. Many factors have to be considered including diagnosis, age, body weight, hepatic function, potential drug interactions, and sedation goal.

Based on these 2 studies, it is reasonable to consider the following dosing strategy:

  • Dexmedetomidine dose of 0.7 mcg/kg/hour or less: clonidine 0.1 to 0.2 mg every 6 to 8 hours
  • Dexmedetomidine dose greater than 0.7 mcg/kg/hour: clonidine 0.2 to 0.3 mg every 6 to 8 hours

References

Dexmedetomidine (Precedex) package insert. Hospira Inc. 2016

Clinical Practice Guideline for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Crit Care Med; 2013; 41 263-306

Dasta JF, Kane-Gill SL, Durtschi AJ: Comparing dexmedetomidine prescribing patterns and safety in the naturalistic setting versus published data. Ann Pharmacother 2004; 38:1130–1135

Cunningham FE, Baughman VL, Tonkovich L, et al: Pharmacokinetics of dexmedetomidine (DEX) in patients with hepatic failure (HF). Clin Pharmacol Ther 1999; 65:128–128

Terry, Kimberly, Rachel Blum, and Paul Szumita. “Evaluating the transition from dexmedetomidine to clonidine for agitation management in the intensive care unit.” SAGE open medicine 3 (2015): 2050312115621767.

Gagnon DJ, Riker RR, Glisic EK, et al. Transition from dexmedetomidine to enteral clonidine for ICU sedation: an observational pilot study. Pharmacotherapy 2015; 35(3): 251–259.

 


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