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Transitioning Patients From Dexmedetomidine (Precedex) To Enteral Clonidine In The ICU Category: Pharmacotherapy by - November 11, 2016 | Views: 16148 | 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


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


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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